The impact of using computer decision-support software in primary care nurse-led telephone triage:Interactional dilemmas and conversational consequences

Murdoch, Jamie, Barnes, Rebecca, Pooler, Jillian, Lattimer, Valerie, Fletcher, Emily and Campbell, John L (2015) The impact of using computer decision-support software in primary care nurse-led telephone triage:Interactional dilemmas and conversational consequences. Social Science & Medicine, 126. pp. 36-47. ISSN 1873-5347

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Abstract

Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. Although computer decision-support software (CDSS) is increasingly used by nurses to triage patients, little is understood about how interaction is organized in this setting. Specifically any interactional dilemmas this computer-mediated setting invokes; and how these may be consequential for communication with patients. Using conversation analytic methods we undertook a multi-modal analysis of 22 audio-recorded telephone triage nurse-caller interactions from one GP practice in England, including 10 video-recordings of nurses' use of CDSS during triage. We draw on Goffman's theoretical notion of participation frameworks to make sense of these interactions, presenting 'telling cases' of interactional dilemmas nurses faced in meeting patient's needs and accurately documenting the patient's condition within the CDSS. Our findings highlight troubles in the 'interactional workability' of telephone triage exposing difficulties faced in aligning the proximal and wider distal context that structures CDSS-mediated interactions. Patients present with diverse symptoms, understanding of triage consultations, and communication skills which nurses need to negotiate turn-by-turn with CDSS requirements. Nurses therefore need to have sophisticated communication, technological and clinical skills to ensure patients' presenting problems are accurately captured within the CDSS to determine safe triage outcomes. Dilemmas around how nurses manage and record information, and the issues of professional accountability that may ensue, raise questions about the impact of CDSS and its use in supporting nurses to deliver safe and effective patient care.

Item Type: Article
Additional Information: Copyright © 2014 Elsevier Ltd. All rights reserved.
Uncontrolled Keywords: uk,primary care,nurse-patient interactions,consultations,computer decision-support systems,conversation analysis,multi-modal analysis
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Faculty of Medicine and Health Sciences > Norwich Medical School
Faculty of Social Sciences > School of Social Work
Depositing User: Pure Connector
Date Deposited: 05 Jan 2015 15:00
Last Modified: 21 Apr 2020 23:42
URI: https://ueaeprints.uea.ac.uk/id/eprint/51597
DOI: 10.1016/j.socscimed.2014.12.013

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