Introduction
Although rare, events with tragic consequences occur
within the context of Swedish Healthcare Direct (SHD),
the national telephone helpline in Sweden. In 2008, for
example, a mother called about her 3-year-old son, who
was vomiting and had severe stomach pain. The telenurses
answering the mother’s first two calls assessed the
boy’s symptoms as gastroenteritis and gave the mother
self-care advice. At her third call, the mother was
referred to the hospital emergency department. However,
the child was dead on arrival at the hospital, and an
autopsy revealed the cause of death to be intestinal
obstruction. In the investigation that followed, the two
telenurses, in individual statements, explained how they
had not felt the need to consult the Computerized Decision
Support System (CDSS) on hand, how they felt
pressured by their employers to keep calls short and no