TY - JOUR
T1 - Limited reliability of experts' assessment of telephone triage in primary care patients with chest discomfort
AU - Erkelens, D C
AU - Rutten, F H
AU - Wouters, L T
AU - de Groot, E
AU - Damoiseaux, R A
AU - Hoes, A W
AU - Zwart, D L
N1 - Funding Information:
Funding: This work was supported by the Department of General Practice of the University Medical Center Utrecht , Associate Professorship-promotion grant of D.L. Zwart, MD, PhD, the foundation “Netherlands Triage Standard” and the foundation “Stoffels-Hornstra.” The views expressed are those of the authors and not necessarily those of the foundations. The funding foundations had no role in study design, data collection and analysis, preparation of the article, or decision to publish.
Publisher Copyright:
© 2020 The Authors
PY - 2020/11
Y1 - 2020/11
N2 -
OBJECTIVE: Root cause analyses of serious adverse events (SAE) in out-of-hours primary care (OHS-PC) often point to errors in telephone triage. Such analyses are, however, hampered by hindsight bias. We assessed whether experts, blinded to the outcome, recognize (un)safety of triage of patients with chest discomfort, and we quantified inter-rater reliability.STUDY DESIGN AND SETTING: This is a case-control study with triage recordings from 2013-2017 at OHS-PC. Cases were missed acute coronary syndromes (ACSs, considered as SAE). These cases were age- and gender-matched 1:8 with the controls, sampled from the remainder of people calling for chest discomfort. Fifteen experts listened to the recordings and rated the safety of triage. We calculated sensitivity and specificity of recognizing an ACS and the intraclass correlation.RESULTS: In total, 135 calls (15 SAE, 120 matched controls) were relistened. The experts identified ACSs with a sensitivity of 0.86 (95% CI: 0.71-0.95) and a specificity of 0.51 (95% CI: 0.43-0.58). Cases were rated significantly more often as unsafe than the controls (73.3% vs. 22.5%, P < 0.001). The inter-rater reliability for safety was poor: ICC 0.16 (95% CI: 0.00-0.32).CONCLUSIONS: Blinded experts rated calls of missed ACSs more often as unsafe than matched control calls, but with a low level of agreement among the experts.
AB -
OBJECTIVE: Root cause analyses of serious adverse events (SAE) in out-of-hours primary care (OHS-PC) often point to errors in telephone triage. Such analyses are, however, hampered by hindsight bias. We assessed whether experts, blinded to the outcome, recognize (un)safety of triage of patients with chest discomfort, and we quantified inter-rater reliability.STUDY DESIGN AND SETTING: This is a case-control study with triage recordings from 2013-2017 at OHS-PC. Cases were missed acute coronary syndromes (ACSs, considered as SAE). These cases were age- and gender-matched 1:8 with the controls, sampled from the remainder of people calling for chest discomfort. Fifteen experts listened to the recordings and rated the safety of triage. We calculated sensitivity and specificity of recognizing an ACS and the intraclass correlation.RESULTS: In total, 135 calls (15 SAE, 120 matched controls) were relistened. The experts identified ACSs with a sensitivity of 0.86 (95% CI: 0.71-0.95) and a specificity of 0.51 (95% CI: 0.43-0.58). Cases were rated significantly more often as unsafe than the controls (73.3% vs. 22.5%, P < 0.001). The inter-rater reliability for safety was poor: ICC 0.16 (95% CI: 0.00-0.32).CONCLUSIONS: Blinded experts rated calls of missed ACSs more often as unsafe than matched control calls, but with a low level of agreement among the experts.
KW - Acute coronary syndrome
KW - Inter-rater reliability
KW - Out-of-hours primary care
KW - Patient safety
KW - Serious adverse events
KW - Telephone triage
UR - https://www.scopus.com/pages/publications/85089429909
U2 - 10.1016/j.jclinepi.2020.07.016
DO - 10.1016/j.jclinepi.2020.07.016
M3 - Article
C2 - 32730853
SN - 0895-4356
VL - 127
SP - 117
EP - 124
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
ER -