Nurses underestimate urgency in 19% of calls

Telephone triage by nurses in out-of-hours services may put patients at risk, with the urgency of one in five cases underestimated, a study has revealed.

A group of 118 triage nurses monitored for the study estimated the urgency of 69 per cent of cases correctly, but underestimated it in 19 per cent of cases and overestimated in 12 per cent.

Researchers from the Radboud University Nijmegen, in the Netherlands, used trained ‘mystery callers’, who contacted out-of-hours services with made-up complaints. A panel of seven GP experts assessed how accurately conditions were triaged.

The nurses were employed at co-ops in the Netherlands, where a nurse triage system similar to that employed in many UK out-of-hours systems operates. Both the nurses and the co-ops were informed in advance that the research would be taking place.

The nurses were deemed to be efficient overall because they were unlikely to overestimate the urgency of patients’ conditions and were likely to identify a problem when one existed.

But because of the proportion of cases in which urgency was underestimated, researchers concluded: ‘This research proves that telephone triage by nurses is efficient but possibly not safe.’

They called for more training for nurses, and double-checking of all nurse decision-making by GP triage experts.

GPC negotiator Dr Richard Vautrey said: ‘It is important for nurses to work within their levels of competency — they need to be able to refer problems on to GPs when they are concerned it may be too complex.’

He said there was a case for GPs doing all triage: ‘They are trained to a higher standard and can work outside the solutions that can be dealt with through the protocols nurses operate to.’

Nurse triage could be a false economy, he added. ‘Although the study suggests nurses are efficient, they are often too cautious and refer too often.’

However, Dr Mark Reynolds, chief executive of south-east England out-of-hours service On Call Care, said the study was ‘a bit unreasonable’.

‘I would like to see a comparison with GP triage,’ he said. ‘Nurses who have been through good training and have good clinical supervision, in my experience, make just as good decisions as many doctors.’

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