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Telephone triage by primary care physicians
S Z Yanovski1, J A Yanovski, J D Malley
1Greenfield Research Center, Department of Family Medicine, Thomas Jefferson University, Philadelphia, PA.
Pediatrics
|April 1, 1992
Summary
Physician experience impacts telephone triage accuracy. Faculty physicians excelled at identifying serious pediatric cases, while experience didn't consistently improve resident or private practitioner decision-making in simulated calls.
Area of Science:
- Pediatrics
- Family Medicine
- Medical Education
Background:
- Accurate telephone triage is crucial for pediatric patient management.
- Assessing the impact of physician experience on telephone decision-making is vital.
Purpose of the Study:
- To compare the telephone decision-making accuracy of physicians with varying experience levels.
- To evaluate if experience in pediatrics or family practice improves telephone triage of pediatric patients.
Main Methods:
- Simulated telephone interviews with a standardized mother presenting three pediatric cases.
- Participants included first-year residents, third-year residents, faculty, and private practitioners.
- Decisions assessed included whether the child needed to be seen that evening.
Main Results:
- Experienced physicians (faculty, third-year residents, private practitioners) were less likely to over-triage non-severe cases compared to first-year residents.
- Faculty demonstrated superior management of a severely dehydrated child scenario.
- A significant portion of residents and private practitioners made inappropriate decisions, with interpretation of information being key, not question quantity.
Conclusions:
- Physician experience does not consistently improve telephone triage accuracy for pediatric patients.
- Faculty physicians showed better judgment in identifying severely ill children via telephone.
- Effective telephone management relies on physician interpretation of gathered information, not just data collection.