Content area
Full Text
Correspondence to Dr Hay Derkx, Dr Paul Janssenweg 149, 5026 RH Tilburg, The Netherlands; [email protected]
Gospel according St John chapter 19 vs 22: ‘What I have written, I have written.’
Introduction
After a telephone consultation at an out-of-hours centre, the call handler writes a medical report to record what has been discussed with the caller. The call handler is the person who actually handles the request for medical advice and is called the triagist.
The report of a telephone consultation serves different purposes. First, it is important to secure continuity of care. The report is the only documented and therefore rapidly accessible source of information about the content of a call. Studies show that between 35 and 50% of all clinical problems presented by telephone are dealt with by advising self care.1 2 These calls might be audio-recorded, but if the patient calls back, the report informs the triagist quickly about the latest telephone contact. Second, the report can be used for medicolegal purposes if a patient has made a complaint about the care provided.3 4 Third, reports can be used for epidemiological research, but the reliability of the symptom or diagnostic orientated codes is limited, as little information is available on the accuracy of the coding process.5 6
In spite of the importance of medical records, no research on reports of telephone consultations with triagists at out-of-hours (OOH) centres could be identified. The first objective of our study was to investigate the quality of the content of information in these reports.
Research with simulated patients visiting a general practitioner (GP) revealed a low correlation between what had been recorded and what had been asked.7 Accordingly, the second objective of our study was to investigate to what extent the reports at out-of-hours centres reflected the content of the telephone consultations.
Methods
Cases, protocols and rating instrument
A focus group was asked to develop an instrument to assess the quality of clinical reports of telephone consultations at an OOH centre. The group consisted of individuals representing the four stakeholders involved in telephone calls to an OOH centre: the patient, the call handler, the general practitioner and the management team. Each party was represented by two members with experience in working at or...