Material and methods
Three casualty clinics took part in the pilot study in response to an open invitation given to clinics and at conferences. Tromsø’s out-of-hours service represents a larger town (63 596 inhabitants), Nordhordland’s service is an intermunicipal cooperative that covers seven municipalities (29 021 inhabitants) and Nes is a medium-sized central rural district (18 022 inhabitants) (2). All three had an organized out-of-hours service with a 24-hour clinic with nurses. The Tromsø - and Nordhordland services had nurses and a doctor in their clinic at all hours, whereas Nes had a doctor on duty in another location than the nurse during the day on weekdays.
The three casualty clinics recorded all requests at all hours for four weeks from 6.3. 2006 to 2.4. 2006. The following variables were recorded for each request/patient: home municipality (number and name of municipality), year, week number, day of the week, time of day or night, sex, age, mode of contact, degree of urgency and action taken. Diagnoses, symptoms or problems were not recorded for the requests. The time of day was defined as day (8 am - 3 29 pm), evening (3 30 pm - 10 59 pm) and night (11 pm - 7 59 am). The degree of urgency (priority grade) was measured according to the Norwegian Index for Medical emergency Assistance (Triage box 1) (3). Data were collected at the individual level and each request counted as a unique entry in the matrix. Data from each week, Monday 00:00 hrs up to and including Sunday 24:00 hrs of the same week, were sent to the National Centre for Emergency Primary Health Care by the end of the following Wednesday.
Definition of priority grades in accordance with the Norwegian Index for Medical emergency Assistance (and triage) (3)
Green priority: Normal
Yellow priority: Urgent
Red priority: Acute
The nurses on duty did the recording. All variables and possible interpretations were explained and clarified with all the nurses and their leaders at meetings with the project leader before the start of the project. The form to be used for recording was also tested out by the clinics beforehand. The nurses were responsible for recording requests to the out-of-hours service consecutively, whereas quality assurance and submitting of data was delegated to a defined project coordinator at each clinic. The project coordinator was to ensure that data from all requests were correctly recorded each week.
The Centre had prepared a recording form in an Excel accounting sheet, which was used by the Nes - and Nordhordland clinics. Tromsø used their own electronic programme (tested and accepted by the Centre beforehand), which was specially suited to the pilot study’s aims.
The statistical programme SPSS version 13.0 was used to analyze the results. Chi-square tests were used and the statistical significance was defined as p < 0.05.