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Advice Nurse Service vs On-Call Pediatricians

Thomas J. Lee, MHS, MD; Larry J. Baraff, MD; Judith Guzy, BSN; David Johnson, PhD; Heide Woo, MD

Arch Pediatr Adolesc Med. 2003;157:635-641.

Background  Advice nurse call centers are used to ensure access to medical advice, thereby potentially reducing the costs of health services.

Objective  To determine if medical advice from advice nurses and on-call physicians delays significant medical treatment in a general pediatrics population.

Design  Randomized controlled trial.

Setting  A university general pediatrics faculty practice.

Participants  Parents or guardians calling for after-hours advice regarding their children.

Intervention  After-hours medical advice calls were randomized at the time of the call to an advice nurse or an on-call pediatrician.

Main Outcome Measures  The proportion of callers who sought medical care not advised by the advice nurse or on-call pediatrician and the proportion who received unadvised significant care.

Results  There were 1182 advice calls: 566 in the pediatrician group and 616 in the advice nurse group. There were no significant differences in the types of telephone triage advice in the physician and advice nurse groups. There was no significant difference in the proportion of callers who sought unadvised care (108 [19.9%] in the physician group vs 110 [19.0%] in the advice nurse group) or in the proportion of callers who received unadvised significant care (23 [4.2%] in the physician group vs 25 [4.3%] in the advice nurse group).

Conclusions  The proportions of callers who sought unadvised medical care and who received unadvised significant care were not significantly different in the advice nurse and pediatrician groups. This suggests that advice nurses do not delay significant medical treatment when compared with pediatricians.

From the Emergency Medicine Center, David Geffen School of Medicine, University of California, Los Angeles (Drs Lee and Baraff and Ms Guzy); Mattel Children's Hospital, UCLA Medical Center, Los Angeles (Drs Baraff and Woo); and McKesson Health Solutions, Broomfield, Colo (Dr Johnson). Dr Johnson is a shareholder of McKesson Corp, Broomfield.

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