Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT04226040 |
Other study ID # |
HvidovreDOW1 |
Secondary ID |
|
Status |
Completed |
Phase |
|
First received |
|
Last updated |
|
Start date |
January 13, 2020 |
Est. completion date |
December 19, 2020 |
Study information
Verified date |
May 2023 |
Source |
Hvidovre University Hospital |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Observational [Patient Registry]
|
Clinical Trial Summary
This study explores whether and how DOW, as a PRO marker, can contribute to triage in the
Emergency Departments. The study is designed as a mixed-method study consisting of a survey
among acutely ill patients and qualitative semi-structured interviews.
Description:
In Emergency Departments (ED) in Denmark and internationally, triage manuals are used to
divide incoming patients according to their acute clinical severity, and thus assess who
should be examined and treated first. However, the triage manuals are criticized for being
imprecise in the intermediate categories. Furthermore, the triage manuals, nationally and
internationally, are criticized for not adequately involving the patient's perspective and
context. In addition, triage is not independent of personal factors and workload, which may
contribute to interprofessional variation. Further, patients themselves express a desire to
be even more involved. Also, the relationship between patient and healthcare professional has
a direct impact on the quality of health services, however, there are divergent perceptions
of what patient involvement entails. Patient-Reported Outcome (PRO) data is one way in which
patient involvement can occur. PRO is data reported directly from the patient without
interference from the healthcare professional and is thus self-reported data, typically
generated through survey studies among patients. A strength of PRO data is that these are
often more sensitive which may, for example, demonstrate a higher degree of severity of the
patient's symptoms. Furthermore, it is considered a strength that PRO data can be used at
both group level, for example in quality assurance, as well as at an individual level to
support the decision making of healthcare professionals and thereby ensure efficient use of
resources. Due to lack of evidence-based knowledge in the field and despite the potential of
using PRO data, the information of patients and / or relatives is not used systematically in
the Emergency Department. This also applies in the acute contact, where an imprecise initial
evaluation of the patient's overall medical needs can cause both over- and under-triaging to
the detriment of the overall patient course. The result is an inappropriate allocation of
resources at the organizational level and a poorer quality in the treatment process. This
points to the need to use relevant patient-reported measures (PROM), the tool for measuring
PROs. One such instrument is Degree-of-Worry (DOW), which measures the patient's
self-reported level of worry. DOW is a ten-point score of self-reported worry (from 1 =
minimal concern to 10 = maximally concerned), reflecting the patient's own assessment of
acute illness and own perception of concern. DOW has been scientifically tested in connection
with telephone triage at the medical helpline 1813 (MH1813) as a five-point score. The
patient's DOW, measured at the time the patient makes his first call to the MH1813, is
strongly associated with the probability of acute hospitalization within 48 hours. However, a
pilot test with DOW as a five-point score in the Emergency Department indicates a ceiling
effect, by which DOW will be presented as a 10-point score in this setting. DOW has the
potential to increase patient safety, create greater patient involvement and increase
efficiency so that the lengths of stay reflects the triage level. A previous study suggests
that DOW could also be used advantageously in other similar settings, such as Emergency
Department, which, however, requires that potential implementation barriers is examined.