Risk Management and Healthcare Policy (May 2021)
Validation of Dutch Obstetric Telephone Triage System: A Prospective Validation Study
Abstract
Bernice Engeltjes,1,2 Corlijn Van Dijk,3 Ageeth Rosman,2 Rudy Rijke,2 Fedde Scheele,1,4 Eveline Wouters5 1Athena Institute for Transdisciplinary Research, Faculty of Science, VU University, Amsterdam, the Netherlands; 2Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands; 3Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands; 4Department of Healthcare Education, OLVG Teaching Hospital, Amsterdam, the Netherlands; 5Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the NetherlandsCorrespondence: Bernice EngeltjesDepartment of Health Care Studies, Rotterdam University of Applied Sciences, Rochussenstraat 198, Rotterdam, 3015 EK, the NetherlandsTel +31 6 41804881Email [email protected] and Purpose: A triage system that prioritizes care according to medical urgency has a favorable effect on safety and efficiency of emergency care. The Dutch obstetric telephone triage system is comparable to physical triage systems. It consists of five urgency levels: resuscitation and life threatening (U1), emergency (U2), urgent (U3), non-urgent (U4) and self-care advice (U5). The purpose of this study was to determine the diagnostic and external validity of the Dutch obstetric telephone triage system in obstetric emergency care.Patients and Methods: The validity of the Dutch obstetric telephone triage system was studied in a prospective observational study in four hospitals. Diagnostic validity of usual care was determined by comparing the assigned urgency level of the Dutch obstetric telephone triage system with a reference standard. This reference standard was obtained by face-to-face clinical assessment in hospital following telephone triage. Clinical follow-up after assessment was also recorded. For statistical analyses, urgency levels were dichotomized into high urgency (U1, U2) and intermediate urgency (U3, U4). Self-care advice (U5) could not be studied because these patients were not referred to hospital.Results: In total, 983 cases (U1-U4) across the four hospitals were included, 625 (64%) cases were categorized as high urgency and 358 (36%) as intermediate urgency. The Dutch obstetric telephone triage system’s urgency level agreed with the reference standard in 53% (n=525; 95% CI 50– 57%). According to the reference standard the Dutch obstetric telephone triage system had undertriage in 16% (n=160) and overtriage in 30% (n=298) of the cases. Sensitivity for high urgency was 76% (95% CI 72– 80), specificity 49% (95% CI 44– 53). Positive predictive value and negative predictive value were 60% (95% CI 56– 63) and 67% (95% CI 62– 72), respectively. After clinical assessment, urgent care was needed in 8.7% (n=31) of the intermediate-urgency cases, none of these cases were life threatening situations.Conclusion: DOTTS shows an acceptable diagnostic validity with room for improvement.Keywords: telephone triage, diagnostic validity, external validity, under-triage, sensitivity, obstetric emergency care
