Elsevier

Women and Birth

Volume 31, Issue 5, October 2018, Pages 414-421
Women and Birth

Telephone triage and midwifery: A scoping review

https://doi.org/10.1016/j.wombi.2017.12.002Get rights and content

Abstract

Background

Midwives use telephone triage to provide advice and support to childbearing women, and to manage access to maternity services. Telephone triage practises are important in the provision of accurate, timely and appropriate health care. Despite this, there has been very little research investigating this area of midwifery practice.

Aim

To explore midwives and telephone triage practises; and to discuss the relevant findings for midwives managing telephone calls from women.

Methods

A five-stage process for conducting scoping reviews was employed. Searches of relevant databases as well as grey literature, and reference lists from included studies were carried out.

Findings

A total of 11 publications were included. Thematic analysis was used to identify key concepts. We grouped these key concepts into four emergent themes: purpose of telephone triage, expectations of the midwife, challenges of telephone triage, and achieving quality in telephone triage.

Discussion

Telephone triage from a midwifery perspective is a complex multi-faceted process influenced by many internal and external factors. Midwives face many challenges when balancing the needs of the woman, the health service, and their own workloads. Primary research in this area of practice is limited.

Conclusion

Further research to explore midwives’ perceptions of their role, investigate processes and tools midwives use, evaluate training programs, and examine outcomes of women triaged is needed.

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.

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