Umeå University's logo

Background: Pre-hospital delay in myocardial infarction (MI) patients' is of great concern. The total ischemic time, i.e., between symptom onset and reperfusion therapy is the most important factor to achieve best possible outcome. One reason for patient delay is choice of first medical Contact (FMC), still not everyone contact the emergency medical services. A previous Swedish cross-sectional multicentre study found that every fifth patient with an evolving ST elevated MI (STEMI) contacted an advisement tele-nurse intended for non-life-threatening situations as FMC. This caused a median difference in delay of 38 min from symptom onset to diagnosis. Advisement tele-nursing is an expanding actor in the Swedish healthcare system, as in some other Western nations.

Purpose: The aim was to explore the communication between tele-nurses and callers when MI patients called a national health advisement number as FMC.

Method: This study had a qualitative approach. We received access to 30 authentic calls. The recordings lasted between 0:39 minutes to 16:44 minutes, transcribed verbatim and analysed with content analysis. The following questions were applied to the transcript: (1) How do the callers communicate their symptom and context (2) How do the tele-nurses respond and which level of care was directed (3) Do the callers get an advice and what action do they take.

Result: One third of the callers were female, aged 46–89 years, six were diagnosed with NSTEMI and 24 with STEMI. All tele-nurses were females. The calls followed a structure of three phases, opening-, orienting- and end-phase. The first phase was non-interfered, where the caller communicated their context and/or symptoms and tele-nurses adopt an active listening position, followed by two interactive phases. Four categories defined the interaction in the communication, indecisive, irrational, distinct or reasoning. The different interactions illustrated how tele-nurses and callers assessed and elaborated upon symptom, context and furthermore expressed the process in the dialogue. Type of interaction was pivotal for progress in the call and had impact on the communicative process either sufficient in reaching a mutual understanding or not. An indecisive or irrational interaction could increase risk of acute care not being recommended. A non explicit explanation, why it is of importance to seek acute care could lead caller to ignore the advice.

Conclusion: Both communicative and medical skills are needed to identify level of urgency. Our study suggests that the interaction in the communication categorised in four types, indecisive, irrational or distinct or reasoning can mislead level of care directed as well as a disability to express the need of acute care. This knowledge adds new perspective and hopefully will our findings be useful to deepen our knowledge in identifying MI patients and in a broader sense improve educational efforts and diminsh delay.