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PubMed1995

Triage of medical or social issues through preoperative and postoperative telephone calls by primary nurses.

A preoperative telephone call from a primary nurse decreases patient's anxiety and allows a medium for triaging medical and/or social issues which could adversely affect patients and/or cause costly delays in operating room start times. This telephone call also establishes a bond with the patient, which continues throughout the patient's hospitalization. The postoperative telephone call by a primary nurse enables the nurse to triage medical/surgical complications and to ensure the patient's understanding of postoperative instructions. The telephone calls are one way of enhancing patient care and the cost effectiveness of health care delivery.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Guidance article: cellular telephones and radio transmitters--interference with clinical equipment.

It has long been recognized that devices emitting radio frequencies can interfere with the operation of clinical and other electronic equipment. A number of Health Devices System members have called us in recent months to ask about the risks of using cellular telephones in hospitals, and several others have also raised similar questions in the Healthcare Technology conference area of ECRINet, our online communication service. While some of those making inquiries have been alarmed by the publicity surrounding the possible health hazards of using cellular telephones--a specter that is not supported by currently available evidence or theoretical considerations--the focus of concern is generally whether such telephones can affect the operation of patient care devices. Evidence indicates that operating cellular telephones and radio transmitters near certain clinical equipment presents the risk of interrupting patient care, although much work remains to be done to clearly define that risk. Nevertheless, we recognize the benefit of bringing to the attention of our readers some of the experiences that are being reported. We hope that the following questions and answers will increase awareness of the possible risks of using such equipment, as well as promote the exchange of information to permit a more rapid assessment of the degree of risk and the steps necessary to avert problems.

Electronics, Medical↗
PubMedDate not supplied

Evaluation of telephoned computer-generated reminders to improve immunization coverage at inner-city clinics.

The authors evaluated the effectiveness of computer-generated telephoned reminders used to raise the rates of on-time immunization among preschool-age children in two public clinics in Atlanta, GA. The overall effect of the intervention on immunization levels appeared to be minimal (crude relative risk = 1.07, 95 percent confidence interval = 0.78, 1.46), in part because only about 80 percent of children in both the randomly selected intervention group and in the control group were members of a household with a telephone number listed in clinic records. However, logistic regression analysis indicated that 36 of 68 children (52.9 percent) in the intervention group whose households were reached were vaccinated within 30 days of their due dates, compared to 31 of 75 children (41.3 percent) in the control group whose household telephone numbers were recorded but not called (adjusted odds ratio = 2.12, 95 percent confidence interval = 1.01, 4.46). This analysis indicates that telephoned reminders demonstrated a level of effectiveness in improving immunization levels at inner-city clinics that recommends further trial and study.

Child Health Services↗
PubMed1993

Real-ear measures in evaluation of frequency response and volume control characteristics of telephone amplifiers.

The spectral frequency response, frequency response range, and volume control linearity of five telephone amplifiers were examined using real-ear measures. All measurements were performed in KEMAR's (Knowles Electronics Manikin for Acoustic Research) ear canal using a composite speech-shaped waveform as the stimulus. Spectral frequency response and response range of each device was obtained at four volume control settings and compared to those of a standard telephone receiver. Only two of the amplifiers replicate the spectral frequency response of the standard receiver and show an increase in the amount of gain provided with increasing volume control rotation. The remaining three amplifiers show a more restricted spectral frequency response and response range when compared to those of the standard receiver. The volume control characteristics of the amplifiers were somewhat more uniform. Overall results indicate that the spectral frequency response and response range of telephone amplifiers can be objectively evaluated using real-ear measures, and these measures are essential in determining the usefulness of certain telephone amplifying devices.

Amplifiers, Electronic↗
PubMed1993

[The telephone accessibility of the prior appointment program].

OBJECTIVE: To determine the ease of access by telephone when making medical appointments. DESIGN: Cross-sectional, observational, random sample. SETTING: Primary care, Murcia Region. PATIENTS AND OTHER PARTICIPANTS: Centres with a previous appointments system (n = 25) and a random sample of the 276 practitioners involved (n = 97). We ruled out 4 practitioners for not having a telephone in their outer consulting room. MEASUREMENTS AND MAIN RESULTS: We made telephone calls until we had obtained appointments with each of the practitioners, across three hour blocks. The result was an average of 2,333 calls/appointment, with a deflection of 2,271. The mode and median were 1, and the range 26. We found differences in the distribution of the calls across the three blocks (p < 0.05). Comparing rural centres with urban, we found a lower average number of calls in the first two blocks (p < 0.01). CONCLUSIONS: Telephone accessibility is at an appropriate level, both in rural and urban areas.

Appointments and Schedules↗
PubMed1996

[Validity of telephone ECG multichannel transmission].

Transtelephonic ECG transmission is an established monitoring system for cardiac patients in many countries around the world with the exception of Germany. This study reports first experiences with a multichannel ECG system using nine leads. This system allows to analyze ECG for ischemic events in addition to cardiac arrhythmias. In this study the reliability of a modified lead registration procedure of the telephonic ECG system David 9 (MAP, München) was compared to conventional 12-lead ECG recording (Mingograph 7, Siemens) in 225 consecutive patients. Comparison was performed using the arm electrodes of the telephonic ECG system (Tel. ECG) within the armpit (group I) or at the wrists (group II). Placing the electrodes at the wrists improved sensitivity and specificity of electrocardiograpic abnormalities to conventional 12 lead ECG (Conv. ECG). Specificity for detection of anterior myocardial infarction was 0.95 (Tel. ECG vs. Conv. ECG), specificity was 1.0. For infero-posterior infarction these relations were 0.94 and 1.0 respectively. ST-segment changes have been detected in the Tel. ECG with 0.93 and 0.89 for specificity and sensitivity. The numbers of arrhythmia analysis were 1.0 and 0.7 for all rhythm disturbances. Detection of atrial fibrillation was less reliable due to short recording time and low amplitude of the transmitted signal. Specificity and sensitivity for detection of ventricular arrhythmias were 1.0 and 0.89. Optimizing the placement of arm electrodes to the wrist instead of armpits as done up to now improved the reliability of the telephonic transmitted ECG. This telephonic ECG system then enables a reliable registration of ischemic and arrhythmic events.

Aged↗
PubMed1997

A computer-administered telephone interview to identify mental disorders.

CONTEXT: Common mental disorders are often not identified in primary care settings. OBJECTIVE: To evaluate the validity and clinical utility of a telephone-assisted computer-administered version of Primary Care Evaluation of Mental Disorders (PRIME-MD), a brief questionnaire and interview instrument designed to identify psychiatric disorders in primary care patients. DESIGN: Comparison of diagnoses obtained by computer over the telephone using interactive voice response (IVR) technology vs those obtained by a trained clinician over the telephone using the Structured Clinical Interview for DSM-IV [Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition] Diagnosis (SCID). A subsample also received the clinician-administered version of PRIME-MD. PATIENTS: Outpatients (N=200) from 4 primary care clinics, an eating disorders clinic, an alcohol treatment facility, psychiatric outpatients, and community controls. SETTING: Interviews conducted by telephone, except for face-to-face administration of PRIME-MD, which was conducted at either the primary care clinic or a research clinic. MEASUREMENTS AND MAIN RESULTS: Prevalence rates for any psychiatric disorder were similar between diagnoses made by the computer and those made by a mental health professional using the SCID (60.0% vs 58.5%). Prevalence rates for individual diagnoses were generally similar across versions. However, primary care patients reported twice as much alcohol abuse on the computer (15.0%) as on either the SCID (7.5%) or the clinician-administered PRIME-MD (7.5%). Using the SCID as the criterion, both the computer- and clinician-administered versions of PRIME-MD demonstrated high and roughly equivalent levels of sensitivity and specificity. Overall agreement (K) for any diagnosis was 0.67 for the computer-administered PRIME-MD and 0.70 for the clinician-administered PRIME-MD. CONCLUSIONS: The computer-administered PRIME-MD appears to be a valid instrument for assessing psychopathology in primary care patients. Interactive voice response technology allows for increased availability, and provides primary care physicians with information that will increase the quality of patient care without additional physician time and at minimal expense.

Adult↗
PubMed1997

AIDS and condoms in Brasilia: a telephone survey.

A telephone survey was conducted to measure AIDS knowledge, media usage and condom attitudes and behaviors among 500 adults aged 18 to 49 in Brasilia, as well as to evaluate the feasibility of the telephone survey method in a developing country. The response rate was 91.6%. Respondents had good knowledge about correct modes of HIV transmission and prevention but also believed HIV was transmitted through blood donation, public toilets, swimming pools, and mosquito bites. TV and newspapers were the most important sources of information on health matters and AIDS, though health workers were considered the most credible sources of such information. Only 19% of sexual encounters in the 4 weeks prior to the survey included condoms. Single and younger respondents and those with more positive attitudes used condoms more frequently. More work is needed to identify appropriate messages to motivate people to use condoms. Telephone surveys regarding AIDS and sexual attitudes and behaviors are feasible in Brasilia, a planned community with universal telephone coverage.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The use of mobile telephones in a district general hospital.

Advances in technology have led to the increased availability of mobile telephones, but their use in an NHS hospital has not previously been reported. Junior doctors require easy access to a telephone, but ward telephones are frequently busy and not readily accessible when urgently needed. A one-year retrospective study was carried out on the use of mobile telephones in a small district general hospital.

Attitude of Health Personnel↗
PubMedDate not supplied

Telephone triage in women's health care.

This article describes the importance of sound telephone triage strategies in women's health care. A brief description of the history of telephone triage is provided as well as basic considerations in establishing a telephone triage system. A sample telephone report sheet is also provided.

Humans↗
PubMed2005

Assessment of cognitive status in the elderly using telephone interviews.

OBJECTIVE: To examine the feasibility to assess cognitive status in the elderly using telephone interviews. RESEARCH DESIGN AND METHODS: From January to December 2003, 740 participants of the ongoing Heidelberg longitudinal study (HeiDE) aged 70 years or more were eligible for a telephone interview on cognitive status. Validated instruments to assess cognitive status, including the Telephone Interview of Cognitive Status (TICS) and the East Boston Memory Test (EBMT, immediate and delayed recall), the Verbal Fluency Test, the HAWIE-"Vocabulary Test" and the HAWIE-"General Knowledge", a prospective memory test, and a digit span backwards-test were translated into German, if applicable. RESULTS: Out of 740 participants at the age of 70 or older, 473 participants were interviewed (64.9%). The total score of the TICS (maximum=best: 41) ranged from 21 to 40 (mean 33.5, SD 3.1; median 34.0). The EBMT scores (immediate recall; maximum=best: 12) ranged from 4 to 12 (mean 9.2, SD 1.7; median 9.0). CONCLUSIONS: Cognitive status could be successfully assessed by telephone interview in elderly participants of an ongoing population-based cohort study. Specifically, some of the tests showed pronounced variability allowing cross-sectional analyses whereas others seem more valuable for longitudinal assessment.

Aged↗
PubMed2005

Decreasing clinically significant adverse events using feedback to emergency physicians of telephone follow-up outcomes.

STUDY OBJECTIVE: We evaluate the effect on adverse events of a telephone follow-up quality improvement program. METHODS: This was a before-and-after intervention comparison based on prospectively collected data in a tertiary care hospital emergency department (ED) (82,000 visits per year). The first half (April 15 to July 31, 2001) served as control, and the second half (August 1 to November 15, 2001) served as intervention with feedback to physicians on telephone follow-up outcomes of discharged patients and resident training about the uncertain presentations of serious diseases and the need to use additional evaluation on selected patients (observation unit, hospital admission). Telephone follow-up of the high-risk patients and retrospective review of 3-day return visits were used to quantify outcome measures: return visits to EDs and clinically significant adverse events (return visits with serious misdiagnoses or an erroneous management plan). The differences in proportions of outcomes were measured with 95% confidence intervals (CIs). RESULTS: High-risk patients were enrolled: 566 (13.7%) of 4,139 discharged patients in the before-intervention period and 397 (11.3%) of 3,507 in the after-intervention period. The quality improvement initiative decreased return visits on enrolled patients from 10.1% (57/566) to 4.9% (19/397) (5.2% difference with 95% CI 1.8% to 8.8%) and decreased clinically significant adverse events from 4.1% (23/566) to 1.5% (6/397) (2.6% difference with 95% CI 0.3% to 4.8%). For all ED discharged patients, clinically significant adverse events decreased from 0.9% (39/4,139) to 0.4% (15/3,507) (0.5% difference with 95% CI 0.1% to 0.9%). During the study, the observation rate increased 4.3% (95% CI 2.8% to 5.7%), and the admission rate increased 3.4% (95% CI 2.1% to 4.8%). CONCLUSION: A quality improvement program with feedback to physicians of telephone follow-up and resident education can decrease clinically significant adverse events in ED discharged patients.

Diagnostic Errors↗
PubMedDate not supplied

Implementing a nurse-led telephone advice system in ophthalmology.

This article describes the background research I undertook to determine the potential for a telephone advice line in this major specialist eye hospital in the United Kingdom. The information gained was used to implement a computer-based telephone assessment system with guidelines. This system enables a registered nurse with an ophthalmic qualification to offer telephone triage and general information and advice about eye problems. The help line was identified as a service that would enhance the care of patients with eye problems, their carers, and health providers. The help line, "Moorfields Direct," was given a dedicated telephone number and was officially launched in February 1999.

Eye Diseases↗
PubMed2000

Telephone crisis intervention skills: a simulated caller paradigm.

Counseling skills were evaluated in a telephone counseling service for Vietnam veterans. Thirty simulated crisis calls were made to telephone counselors by experienced clinical psychologists. The counselors' responses were rated on dimensions that indexed general counseling skills, knowledge of veteran needs, and provision of appropriate advice. Whereas the majority of callers demonstrated adequate counseling skills, many lacked knowledge of veterans' posttraumatic stress, common veteran terminology, and the nature of veterans' experiences. The findings suggest that telephone counseling services that target specific populations should employ comprehensive training to ensure that counselors possess adequate and relevant knowledge about callers and their presenting problems. The simulated caller paradigm appears to be an effective paradigm for training and evaluation of telephone counselors.

Counseling↗
PubMed2003

Access to NHS dentistry in South Cheshire: a follow up of people using telephone helplines to obtain NHS dental care.

OBJECTIVE: To follow up calls made to NHS Direct and South Cheshire Dental Helpline concerning getting access to an NHS dentist in South Cheshire. DESIGN: Contact details of callers who had consented to a follow up call were passed by helpline staff to a researcher at regular intervals. In a structured interview, callers were asked why they had telephoned the helpline and whether they had subsequently obtained NHS dental care. Follow up calls continued until a total of 200 replies had been gathered, either by telephone or post (for those where telephone contact could not be made). Follow up calls were made between September 2001 and March 2002. RESULTS: During the study period only three callers from South Cheshire contacted NHS Direct with a dental access query and consented to a follow up call, compared with 219 callers to South Cheshire Dental Helpline. Only 10% were not contacted either by telephone or post. A comparison with figures for calls made to South Cheshire Dental Helpline between April 2000 and March 2001 suggests that during the study period a year later the access problem has improved. However, there were still a few areas in South Cheshire where significant numbers of dental access queries were being received. Twenty five per cent of unregistered and 22% of registered callers still felt that they had problems getting access to NHS dental care after using information from the helplines. CONCLUSION: A small but significant number of people in South Cheshire have problems accessing NHS dental care.

Adolescent↗
PubMed1998

Providing psycho-social support by telephone: what is its potential in cancer patients?

This paper provides an overview of the use of supportive telephone interventions in cancer patients. The small number of studies that have been reported to date have demonstrated that such approaches are feasible and well accepted. Current telephone counselling programmes for cancer patients have utilized both one-to-one and group approaches. Given the promise of telephone interventions to provide assistance to patients who may not otherwise receive psycho-social care because of factors such as geographical isolation, physical limitations, or lack of comfort with face-to-face approaches, further development and evaluation of programmes in this area is critically needed. We identify priorities for future research, including determining the most effective ways to deliver telephone interventions, identifying patient groups in which they are most successful, and evaluating cost-effectiveness.

Counseling↗
PubMed2002

Agency nursing in Melbourne, Australia: a telephone survey of hospital and agency managers.

BACKGROUND: Agency nursing is a poorly understood and under-researched phenomenon. Despite the considerable costs and possible benefits of using agency nurses, little is known about the nature of agency nursing from different perspectives, including hospital and agency managers. AIM: To describe the professional relationship between hospitals and nursing agencies, utilization trends of agency nurses, and institutional policies relating to the employment of agency nurses. METHODS: A telephone survey was conveyed to managers of 70 acute hospitals (service purchasers) and 26 agencies (service providers) to provide baseline information on the utilization of agency nurses in acute hospitals in Melbourne, Australia. Introductory telephone calls were made to the chief nursing officers of the hospitals and the chief executive officers of nursing agencies in order to explain and seek approval for the proposed project. Approval to conduct telephone interviews was obtained from 30 acute hospitals and six agencies, representing a response rate of 43% and 23%, respectively. Separate questionnaires were used for the two categories of respondent. In some cases the questionnaire could not be completed using the telephone and a copy was then sent by post for completion. RESULTS: Findings revealed the high utilization of agency nurses in hospitals, the limited nature of continuing education for agency nurses, tensions between matching agency nurse qualifications with acute specialty needs and the notion that agencies preferred nurses to be flexible in their work assignments. CONCLUSIONS: The study was limited by the fact that the final sample was small (30 hospitals and six agencies), and therefore may not be representative of the wider population of Melbourne hospitals or agencies. However, it provided evidence on the utilization of agency nurses in public and private hospitals that will help shape policy on the regulation of the agency nursing workforce.

Attitude of Health Personnel↗
PubMed2001

Monitoring of dietary changes by telephone interviews: results from Denmark.

OBJECTIVES: To monitor trends in Danish food habits with respect to selected key elements, from 1995 to 1998, and to evaluate the appropriateness of the method developed for that purpose. DESIGN AND METHOD: Two cross-sectional population surveys, in 1995 and 1998. Data collection by computer-assisted telephone interviews including 10 food-frequency questions, questions on type of fat used on sandwiches and drinking milk, and check questions on the previous day. Reproducibility was tested in a subgroup (n = 222) in the 1998 survey. SETTING: The Danish Nutrition Council initiated the survey. SUBJECTS: Men and women aged 15-90 years, 1007 in 1995 and 1024 in 1998. Samples of private telephone numbers were drawn from regional telephone registers, geographically stratified. Participation rates were 62%. RESULTS: Significant differences were observed between 1995 and 1998, some of these in accordance with dietary guidelines (decreased use of whole milk and fat spread on bread, increased use of skimmed milk, salad vegetables, rice/pasta and fish). Other changes were opposite to dietary guidelines (increased use of soft butter, decreased use of soft margarine and low-fat spreads, potatoes, and fresh fruit). Differences in average consumption frequency amounted to 4-13%. Several results were confirmed by comparison with other data, and the reproducibility of the method was acceptable. Data were suitable for analysis of food use patterns, a relevant approach when assessing food habits in a lifestyle context. CONCLUSIONS: The changes observed illustrate the dynamics of food habits and the need for frequent monitoring. This simple telephone method may be a valuable tool for that purpose, as a supplement to national dietary surveys, also in a public health context.

Adolescent↗