• Alicia O'cathain, Jon Nicholl, Fiona Sampson, Stephen Walters, Ann McDonnell, and James Munro.
• Medical Care Research Unit, School of Health and Related Research, University of Sheffield, UK.
• J Health Serv Res Policy. 2004 Oct 1;9(4):226-33.

ObjectivesTo determine whether nurses with different clinical backgrounds make different triage decisions in NHS Direct, the 24-hour telephone helpline staffed by nurses.MethodsMixed methods including semistructured interviews with 24 nurses and a multilevel analysis of 60 794 calls triaged by 296 nurses.ResultsNurse accounts helped to identify nurse characteristics that might affect decision-making. The proportion of calls triaged to self-care was 40% (24 049/60 794), varying by individual nurse from a 10th centile of 22% to a 90th centile of 60%, after adjustment for the age and sex of the patient and the time of the call. Variability was partly explained by the length of clinical experience of nurses and the type of software used: nurses with more than 20 years clinical experience were more likely to triage callers to self-care than those with less than ten years experience (42% versus 36%, respectively; odds ratio = 1.41, 95% confidence interval 1.13, 1.78). Proportions triaged to selfcare differed by the type of clinical decision support software used: 31%, 37% and 44%. There was no evidence that the clinical background of nurses (hospital or community), their length of experience in NHS Direct, the range of their experience, or their gender affected triage decisions. Interviews identified that nursing characteristics affected individual nurses in different ways and helped to generate a hypothesis for future research - that individual nurses' approaches to risk may influence triage decisions.ConclusionThere is no likely benefit in narrowing nurse recruitment to particular clinical backgrounds. The appropriateness of triage decisions still needs to be evaluated.

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