Ong RSG et al. 2008 "Call-duration and triage decisions in out of hours cooperatives with and without the use of an expert system."
Reference
Ong RSG, Post J, van Rooij H, et al. Call-duration and triage decisions in out of hours cooperatives with and without the use of an expert system. BMC Fam Pract 2008;9:11.
Abstract
"Background: Cooperatives delivering out of hours care in the Netherlands are hesitant about the use of expert systems during triage. Apart from the extra costs, cooperatives are not sure that quality of triage is sufficiently enhanced by these systems and believe that call duration will be prolonged drastically. No figures about the influence of the use of an expert system during triage on call duration and triage decisions in out of hours care in the Netherlands are available.
Methods: Electronically registered data concerning call duration and triage decisions were collected in two cooperatives. One in Tilburg, a cooperative in a Southern city of the Netherlands using an expert system, and one in Groningen, a cooperative in a Northern city not using an expert system. Some other relevant information about the care process was collected additionally. Data about call duration was compared using an independent sample t-test. Data about call decisions was compared using Chi Square.
Results: The mean call time in the cooperative using the TAS expert system is 4.6 minutes, in the cooperative not using the expert system 3.9 minutes, a significant difference of 0.7 minutes (0.4 - 1.0, 95% CI) minutes. In the cooperative with an expert system a larger percentage of patients is handled by the assistant, patients are less often referred to a telephone consultation with the GP and are less likely to be offered a visit by the GP. A quick interpretation of the impact of the difference in triage decisions, show that these may be large enough to support the hypothesis that longer call duration is compensated for by less contacts with the GP (by telephone or face-to-face). There is no proof, however, that these differences are caused by the use of the triage system. The larger amount of calls handled by the assistant may be partly caused by the fact that the assistants in the cooperative with an expert system more often consult the GP during triage. And it is not likely that the larger amount of home visits in Groningen can be attributed to the absence of an expert system. The expert system only offers advice whether a GP should be seen, not in which way (by consultation in the office or by home visit).
Conclusion: The differences in call times between a cooperative using an expert system and a cooperative not using an expert system are small; 0.4 - 1.0 min. Differences in triage decisions were found, but it is not proven that these can be contributed to the use of an expert system."
Methods: Electronically registered data concerning call duration and triage decisions were collected in two cooperatives. One in Tilburg, a cooperative in a Southern city of the Netherlands using an expert system, and one in Groningen, a cooperative in a Northern city not using an expert system. Some other relevant information about the care process was collected additionally. Data about call duration was compared using an independent sample t-test. Data about call decisions was compared using Chi Square.
Results: The mean call time in the cooperative using the TAS expert system is 4.6 minutes, in the cooperative not using the expert system 3.9 minutes, a significant difference of 0.7 minutes (0.4 - 1.0, 95% CI) minutes. In the cooperative with an expert system a larger percentage of patients is handled by the assistant, patients are less often referred to a telephone consultation with the GP and are less likely to be offered a visit by the GP. A quick interpretation of the impact of the difference in triage decisions, show that these may be large enough to support the hypothesis that longer call duration is compensated for by less contacts with the GP (by telephone or face-to-face). There is no proof, however, that these differences are caused by the use of the triage system. The larger amount of calls handled by the assistant may be partly caused by the fact that the assistants in the cooperative with an expert system more often consult the GP during triage. And it is not likely that the larger amount of home visits in Groningen can be attributed to the absence of an expert system. The expert system only offers advice whether a GP should be seen, not in which way (by consultation in the office or by home visit).
Conclusion: The differences in call times between a cooperative using an expert system and a cooperative not using an expert system are small; 0.4 - 1.0 min. Differences in triage decisions were found, but it is not proven that these can be contributed to the use of an expert system."
Objective
"To gain more insight into call duration, triage decisions and the way they affect total care time, answers were sought to the following questions: 'Is there a difference between call duration of a cooperative using an expert system and one not using it?' and 'Is there a difference in triage decisions between a cooperative using an expert system and one not using it?'"
Type Clinic
Primary care
Size
Small and/or medium
Geography
Urban
Other Information
Two out of hours cooperatives in the Netherlands were studied. An out of hours cooperative is the source of evening, weekend, and late-night medical care for the patients of a group of 50 or more general practitioners.
Type of Health IT
Decision support system
Type of Health IT Functions
The expert system uses protocols and algorithms to "[support] the assistant in making the right triage decision. [It shows] the important triage-questions the assistant needs to ask and offer[s] triage advice based on the answers gathered." During triage, the medical assistant receives the call from the patient and decides which of four possible outcomes are appropriate. (1) The assistant gives advice during the call. "A log recording the triage-specifics (questions asked and answers given) is made afterwards, and within a few hours a GP will check the triage decision and authorise it if he/she agrees. If the GP disagrees with the triage decision, the patient will be called back and informed." (2) The GP gives telephone advice without an office consultation or a home visit in the same shift. (3) The patient is invited to come to the center for a consultation. (4) The patient is offered a home visit. "Sometimes assistants will consult a GP during the call if they are unsure about a decision."
Workflow-Related Findings
"Mean call duration in the cooperative using the expert system is 4.6 minutes," which is 0.7 minutes longer than the mean call duration in the cooperative which does not use an expert system.
"A larger percentage of calls in [the cooperative with the expert system] is
handled by the assistant, less patients are offered [telephone advice from the GP] and home visits." The difference "between [the two cooperatives] may well be caused by a different organisation of the care-process. In [the cooperative with the expert system] the assistants consult the practitioner during triage in 21% of the calls, whereas in [the other cooperative] this occurs in 4%. It is possible that in [the cooperative with the expert system] a considerably higher percentage of the patients would have been referred... if there had not been the opportunity of consultation."
handled by the assistant, less patients are offered [telephone advice from the GP] and home visits." The difference "between [the two cooperatives] may well be caused by a different organisation of the care-process. In [the cooperative with the expert system] the assistants consult the practitioner during triage in 21% of the calls, whereas in [the other cooperative] this occurs in 4%. It is possible that in [the cooperative with the expert system] a considerably higher percentage of the patients would have been referred... if there had not been the opportunity of consultation."
Study Design
Only postintervention (no control group)
Study Participants
The study participants included general practitioners (GPs), medical assistants, and patients calling the out of hours cooperatives during the period of the study.