Quality of communication during telephone triage at Dutch out-of-hours centres

Objective: To assess the quality of communication skills of triagists, working at out-of-hours (OOH) centres, and to determine the correlation between the communication score and the duration of the telephone consultation. Methods: Telephone incognito standardised patients (TISPs) called 17 OOH centres presenting different clinical cases. The assessment of communication skills was carried out using the RICE-communication rating list. The duration of each telephone consultation was determined. Results: The mean overall score for communication skills was 35% of the maximum feasible. Triagists usually asked questions about the clinical situation correctly and little about the patients' personal situation, perception of the problem or expectation. Advice about the outcome of triage and self-care advice was usually given without checking for patients' understanding and acceptance of the advice. Calls were often handled in an unstructured way, without summarizing or clarifying the different steps within the consultation. There was a positive correlation of 0.86 (p < 0.01) between the overall communication score and the duration of the telephone consultation. Conclusion: Assessment of communication skills of triagists revealed specific shortcomings and learning points to improve the quality of communication skills during telephone triage. Practice implications: Training in telephone consultation should focus more on patient-centred communication with active listening, active advising and structuring the call. Apart from adequate communication skills, triagists need sufficient time for telephone consultation to enable high quality performance. (C) 2008 Elsevier Ireland Ltd. All rights reserved.