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Computerized Pediatric Telephone Triage and Advice Programs at Children's Hospitals
Operating and Financial Characteristics
Sanford M. Melzer, MD;
Steven R. Poole, MD
Arch Pediatr Adolesc Med. 1999;153:858-863.
Objective To describe the operating characteristics, financial performance, and perceived value of computerized children's hospital–based telephone triage and advice (TTA) programs.
Design A written survey of all 32 children's hospital–based TTA programs in the United States that used the same proprietary pediatric TTA software product for at least 6 months.
Main Outcome Measures The expense, revenues, and perceived value of children's hospital–based TTA programs.
Results Of 30 programs (94%) responding, 27 (90%) were eligible for the study and reported on their experience with nearly 1.3 million TTA calls over a 12-month period. Programs provided pediatric TTA services for 1560 physicians, serving an average of 82 physicians (range, 10-340 physicians) and answering 38,880 calls (range, 8500-140,000 calls) annually. The mean call duration was 11.3 minutes and the estimated mean total expense per call was $12.45. Of programs charging fees for TTA services, 16 (59%) used a per-call fee and 7 (26%) used a monthly service fee. All respondents indicated that fees did not cover all associated costs. Telephone triage and advice programs, when examined on a stand-alone basis, were all operating with annual deficits (mean, $447,000; median, $325,000; range, $74,000–$1.3 million), supported by the sponsoring children's hospitals and their companion programs. Using a 3-point Likert scale, the TTA program managers rated the value of the TTA program very highly as a mechanism for marketing to physicians (2.85) and increasing physician (2.92) and patient (2.80) satisfaction.
Conclusions Children's hospital–based TTA programs operate at substantial financial deficits. Ongoing support of these programs may derive from the perception that they are a valuable mechanism for marketing and increase patient and physician satisfaction. Children's hospitals should develop strategies to ensure the long-term financial viability of TTA programs or they may have to discontinue these services.
From the Department of Pediatrics, Children's Health Care System, University of Washington School of Medicine, Seattle (Dr Melzer); and the Children's Hospital, University of Colorado School of Medicine, Denver (Dr Poole).
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