Factors affecting medical file documentation during telephone triage at an emergency call centre: a cross-sectional study of out-of-hours home visits by general practitioners in France

In France, general practitioners (GPs) perform out-of-hours home visits (OOH-HVs) after physician-led telephone triage at the emergency call centre. The quality of a systematic physician-led triage has not been determined in France and may affect the efficiency of the OOH-HV process. The objectives...

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Bibliographic Details
Published in:	BMC health services research Vol. 19; no. 1; p. 531
Main Authors:	Heidet, Matthieu, Canoui-Poitrine, Florence, Revaux, François, Perennou, Thomas, Bertin, Maeva, Binetruy, Charles, Palazzi, Julien, Tapiero, Eric, Nguyen, Michel, Reuter, Paul-Georges, Lecarpentier, Eric, Vaux, Julien, Marty, Jean
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 30-07-2019 BioMed Central BMC
Subjects:	Call centers Cross-sectional studies Emergency call Centre France General practitioners Hospital emergency services Life Sciences Medical care Medical care quality Medical records Organization Out-of-hours primary care Physicians Practice Quality Quality management Santé publique et épidémiologie Telephone triage France Telephone triage Emergency call Centre Out-of-hours primary care Organization Quality
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Summary:	In France, general practitioners (GPs) perform out-of-hours home visits (OOH-HVs) after physician-led telephone triage at the emergency call centre. The quality of a systematic physician-led triage has not been determined in France and may affect the efficiency of the OOH-HV process. The objectives of this study were first, to evaluate the quality of reporting in the electronic patient's file after such triage and second, to analyse the factors associated with altered reporting. Cross-sectional study in a French urban emergency call centre (district of Paris area) from January to December 2015. For a random selection of 30 days, data were collected from electronic medical files that ended with an OOH-HV decision. Missing key quality criteria (medical interrogation, diagnostic hypothesis or ruled-out severity criteria) were analysed by univariate then multivariate logistic regression, adjusted on patient, temporal and organizational data. Among 10,284 OOH-HVs performed in 2015, 748 medical files were selected. Reasons for the encounter were digestive tract symptoms (22%), fever (19%), ear nose and throat symptoms, and cardiovascular and respiratory problems (6% each). Medical interrogation was not reported in 2% of files (n = 16/748) and a diagnostic hypothesis in 58% (n = 432/748); ruled-out severity criteria were not reported in 60% (n = 449/748). On multivariate analysis, altered reporting was related to the work overload of triage assistants (number of incoming calls, call duration, telephone occupation rate; p < 0.03). In the electronic files of patients requiring an OOH-HV by a GP in a French urban area, quality in medical reporting appeared to depend on organizational factors only, especially the triage assistants-related work factors. Corrective measures are needed to ensure good quality of triage and care.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 PMCID: PMC6668156
ISSN:	1472-6963 1472-6963
DOI:	10.1186/s12913-019-4350-4