How consistent is the advice given by nurses on telephone advice lines? Not very, according to a new US survey.

The study showed that nurses operating a telephone triage system in which calls are sorted according to how urgent they are rarely agreed on the advice they gave to callers, even when they were supposed to be following rigid protocols. The nurses in question were trained by physicians at the University of New Mexico’s Department of Emergency Medicine and then tested with phone calls from mock parents.

The nurses rarely followed the same protocol, and the advice they gave was startlingly variable, say the researchers. Their recommendations disagreed in every case, even though there were only five available advice options. Even when the test case was simple, such as a child having an asthma attack, the parent was given four different recommendations, ranging from home care to an immediate visit to the emergency department.

Telephone triage is currently being adopted by many countries. However, these findings suggest that protocols should be studied and applied more rigorously to avoid giving confusing and conflicting advice.

Head researcher Jane Brillman believes that the best way to find out if telephone triage works is by following up those who are on the receiving end of the advice, “but that is rarely done because it is a lot of work”. Not very encouraging news for a patient who urgently needs medical advice (Ann Emerg Med, 1999; 33: 388-94).

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Written by What Doctors Don't Tell You

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