Telephone triage and midwifery: A scoping review
Introduction
Triage was introduced into hospital settings during the 1950s and 1960s due to high patient volumes in emergency departments.1 Triage is defined as the process to determine level of urgency and type of health care required.2 It requires the caregiver to ask questions, assess urgency, and make clear decisions regarding appropriate advice and referral.2 Recognised internationally as a means for managing access to health care, triage aims to reduce the demands on the health service.3 Triage via the telephone has developed as access to telephones became prolific in households throughout the twentieth century.
In maternity care, the telephone is a means for a woman to establish contact with a health care provider. Bunn et al.4 describe telephone triage as the process where a health care practitioner receives a telephone call, assesses the caller’s concerns, and determines a plan of management. The goal of maternity telephone triage is not to diagnose, but to identify if the woman requires face-to-face assessment or referral to a more appropriate service.5 Midwives perform a degree of triage whenever a woman telephones with a matter outside of a planned appointment. However, midwives themselves may not refer to this function as triage in its purest sense.
Whilst much has been written about triage in other disciplines such as nursing, predominantly in emergency departments6, 7 and primary care settings,8, 9 less is known about the practice of telephone triage by midwives. There are many factors to consider in relation to telephone triage, including whether there are specific skills or knowledge required; core competencies; transferrable in-person assessment skills; importance of consistency of advice; purpose of telephone triage in the maternity setting; clinical outcome measures; legal considerations; managing risk; if specific education or training is required; workload impacts; and relevance of experience8, 10, 11, 12.
Poor quality telephone consultations may lead to inappropriate admissions associated with increased health care or maternal costs, dissatisfaction from women, decreased job satisfaction for midwives, and raised maternal or perinatal risk.2, 5, 8, 13 Considering the importance of midwives’ ability to perform telephone triage, this scoping review explores midwives current practice of telephone triage with the purpose of informing future research, midwifery education and the health care industry.
Section snippets
Methodology
A scoping review is ‘a form of knowledge synthesis that addresses an exploratory research question aimed at mapping key concepts, types of evidence, and gaps in the research related to a defined area or field by systematically searching, selecting, and synthesizing existing knowledge’.14, p. 1292 The opportunity to capture a wide range of study designs and as a technique to map the literature makes the scoping review suitable for exploration of midwifery and telephone triage. A preliminary
Descriptive summary and thematic analysis
The review revealed articles published between 1999 and 2014. Authorship of the papers is dominated by the United Kingdom (n = 8) then the United States (n = 3). The three US based publications occurred from 1999 to 2000, whilst all other publications were UK based from 2004 to 2014. No other countries were identified in the search on this topic in the discipline of midwifery. Four papers were quality improvement (QI) projects, four were discussion papers, two papers are clinical audits, and one
Discussion
This scoping review identified 11 relevant publications spanning 15 years, involving work on the topic in the UK and US. This scoping review was conducted to examine what is known about telephone triage and midwifery practice, and the key recommendations of research into this midwifery practice. Findings suggest there are many positive aspects to having telephone triage available to childbearing women, both for the woman and the midwife. However, findings also reveal the many challenges faced
Strengths and limitations
This topic area suited the scoping study methodology as there were limited experimental studies identified.15 This review has allowed us to investigate what is currently known about midwives and telephone triage and what factors influence safe and effective practice. However, as with all reviews some limitations need to be acknowledged. Only English language papers were included that may have resulted in relevant studies missed. A limitation that we anticipated was the volume of evidence that
Conclusion
Telephone triage by midwives is a necessary component of maternity care, and midwives face similar challenges to other health professionals providing this service. The findings from this review establish that telephone triage from a midwifery perspective is a complex multi-faceted process influenced by many internal and external factors. There are important implications for midwives, women and health services if not performed effectively. Available research suggests that strong communication
Author agreement
This article is the original work of Carolyn Bailey, Jennifer Newton, and Helen Hall. All authors have seen and approved the manuscript submitted. The authors abide by the copyright terms and conditions of Elsevier and the Australian College of Midwives.
This article has not been published, or submitted for publication elsewhere.
Ethical statement
Not applicable for a literature review.
Acknowledgements
The authors declare that there are no potential conflicts of interest in relation to the research, composition and/or publication of this literature review. This work was completed as part of a PhD project with the School of Nursing and Midwifery, Monash University through an Australian Government Research Training Program (RTP) Scholarship.
References (29)
The utilization of nurse-midwives as providers of obstetric triage services: results of a national survey
J Midwifery Womens Health
(1999)- et al.
The effects of intervention on quality of telephone triage at an emergency unit in Finland: nurses’ perspective
Int Emerg Nurs
(2016) - et al.
The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: a secondary analysis of cross-sectional data from the ESTEEM trial
Int J Nurs Stud
(2016) - et al.
Early labour services: changes, triggers, monitoring and evaluation
Midwifery
(2013) - et al.
Scoping reviews: time for clarity in definition, methods, and reporting
J Clin Epidemiol
(2014) - et al.
Midwives’ beliefs and concerns about telephone conversations with women in early labour
Midwifery
(2014) - et al.
Safety of telephone triage in out-of-hours care: a systematic review
Scand J Prim Health Care
(2011) - et al.
Ambiguous and arbitrary: the role of telephone interactions in rural health service delivery
Aust J Prim Health
(2016) - et al.
Telephone consultation and triage: effects on health care use and patient satisfaction
Cochrane Database Syst Rev
(2004) - et al.
Role of telephone triage in obstetrics
Obstet Gynecol Surv
(2012)
The appropriateness of, and compliance with, telephone triage decisions: a systematic review and narrative synthesis
J Adv Nurs
Nurses’ experiences with telephone triage and advice: a meta-ethnography
J Adv Nurs
Nurse telephone triage: good quality associated with appropriate decisions
Fam Pract
Improving quality and safety of telephone based delivery of care: teaching telephone consultation skills
Qual Saf Health Care
Cited by (10)
Clinical decision support system in emergency telephone triage: A scoping review of technical design, implementation and evaluation
2024, International Journal of Medical InformaticsEndorsed midwives prescribing scheduled medicines in Australia: A scoping review
2024, Women and BirthPatients’ experiences with an obstetric telephone triage system: A qualitative study
2023, Patient Education and CounselingCitation Excerpt :In practice however, it is usual for most pregnant women to first make a telephone call before deciding whether it is necessary to have a consultation at the (obstetric) emergency department. Therefore, in most instances the very first triage is performed by telephone and occurs before the pregnant woman is clinically assessed [2,3,5,29,30]. Implementation of a telephone triage system with prepared questions can be experienced as being less tailored to the patient.
The initiation of labour at term gestation: Physiology and practice implications
2020, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :The authors concluded that telephone contact with women in relation to early labour should be undertaken by health care providers dedicated to this task. A recent review of studies of telephone triage for a range of situations in maternity care concluded that there is not enough primary research in this area to reach a firm conclusion about its benefits or disadvantages [73]. The authors note that the findings are in line with previous research [56,72] which indicated that negotiating with women about facility entry in early labour is a complex process in which midwives have to balance the needs of the woman and moment-to-moment changes in labour ward conditions.
Telephone triage in midwifery practice: A cross-sectional survey
2019, International Journal of Nursing StudiesCitation Excerpt :Documentation is important as it provides written evidence of the call taking place, what has been said, legal coverage for the clinician, and pertinent information for colleagues should the caller telephone again or present to the service (Ström et al., 2006). Despite identification that telephone triage training should be provided (Bailey et al., 2018), training was identified as infrequent in the current study. Where training is discussed in the literature, consistent recommendations are made for particular topics.