 |
|
Appropriateness of Urgent Referrals by Nurses at a Hospital-Based Pediatric Call Center
Allison Kempe, MD, MPH;
Catherine Dempsey, MPH;
Julie Whitefield, MD;
Joan Bothner, MD;
Todd MacKenzie, PhD;
Steven Poole, MD
Arch Pediatr Adolesc Med. 2000;154:355-360.
Objectives To evaluate (1) the appropriateness of the after-hours referral (AHR), (2) clinical characteristics of urgently referred patients, and (3) parental compliance with disposition recommendations by the After-Hours Call Center of the Children's Hospital, Denver, Colo.
Subjects Patients of Denver, Colo, pediatricians who called after office hours were triaged by nurses using a computerized triage system, and were referred for after-hours evaluation to 1 of 5 urgent care sites (N=409).
Design Data were collected at each site for 2-week periods every 3 months, from October 1996 to October 1997 (total study period, 10 weeks). Appropriateness of AHRs (diagnoses, clinical interventions, and final dispositions) were determined by a questionnaire that was completed by the evaluating physician. Parental compliance with the AHR was assessed by review of the after-hours site patient database and by telephone survey.
Results Of the referred patients, 339 (82.9%) complied with the recommendation for AHR and, of these, physician questionnaires were completed for 332 (97.9%). The mean percentage of evaluated patients judged appropriate was 90.7% and did not differ statistically by site or by physician training. A history indicating a potentially serious condition was the most common reason for judging a referral appropriate (80.1%), followed by patient discomfort (53.3%), findings from a physical examination (42.5%), parental anxiety (41.5%), and an urgent need for diagnostic test or therapy (34.7%). Of evaluated patients, 37.0% had a diagnostic test, and in 43.5% of cases, the evaluating physician thought a therapeutic intervention was necessary that night. Of the total sample, 93.4% were discharged and 6.6% were admitted to the hospital. The major reasons given by families for noncompliance were lack of understanding of the disposition recommendation and disagreement with the need for urgent referral.
Conclusions Approximately 90% of patients who complied with a referral for urgent evaluation by the After-Hours Call Center were judged by the evaluating physician to have been appropriately referred. The appropriateness rate for all referrals may be lower if there is significant self-selection in those families who do not comply.
From the Departments of Pediatrics (Drs Kempe, Bothner, MacKenzie, and Poole) and Preventive Medicine and Biometrics (Drs Kempe and MacKenzie), University of Colorado Health Sciences Center, Denver; and the Research Institute at The Children's Hospital, Denver (Drs Kempe and Whitefield and Ms Dempsey).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
The Host Hospital 24-Hour Underreferral Rate: An Automated Measure of Call-Center Safety
Hirsh et al.
Pediatrics 2007;119:1139-1144.
ABSTRACT
| FULL TEXT
Pediatric Telephone Call Centers: How Do They Affect Health Care Use and Costs?
Bunik et al.
Pediatrics 2007;119:e305-e313.
ABSTRACT
| FULL TEXT
How Safe Is Triage by an After-Hours Telephone Call Center?
Kempe et al.
Pediatrics 2006;118:457-463.
ABSTRACT
| FULL TEXT
An Assessment of Pediatric After-hours Telephone Care: A 1-Year Experience
Belman et al.
Arch Pediatr Adolesc Med 2005;159:145-149.
ABSTRACT
| FULL TEXT
Use of a Telephone Nursing Line in a Pediatric Neurology Clinic: One Approach to the Shortage of Subspecialists
Letourneau et al.
Pediatrics 2003;112:1083-1087.
ABSTRACT
| FULL TEXT
Parental Compliance with After Hours Telephone Triage Advice: Nurse Advice Service versus On-Call Pediatricians
Lee et al.
CLIN PEDIATR 2003;42:613-619.
ABSTRACT
Caller Satisfaction With After-Hours Telephone Advice: Nurse Advice Service Versus On-Call Pediatricians
Melzer et al.
Pediatrics 2003;112:446-447.
FULL TEXT
Pediatric After-hours Telephone Triage and Advice: Who Benefits and Who Pays?
Melzer
Arch Pediatr Adolesc Med 2003;157:617-618.
FULL TEXT
Does Telephone Triage Delay Significant Medical Treatment?: Advice Nurse Service vs On-Call Pediatricians
Lee et al.
Arch Pediatr Adolesc Med 2003;157:635-641.
ABSTRACT
| FULL TEXT
|
