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How safe is triage by an after-hours telephone call center?
Allison Kempe1, Maya Bunik, Jennifer Ellis
1Department of Pediatrics, Children's Hospital, 1056 E 19th Ave, B032, Denver, Colorado 80218, USA. kempe.allison@tchden.org
Insights
Compliance with pediatric after-hours call center recommendations was high for urgent and home care dispositions but lower for intermediate ones. Potential underreferral leading to hospitalization was infrequent, with younger age and late-night triage being risk factors.
Area of Science:
- Pediatric Healthcare
- Telehealth Services
- Clinical Triage
Background:
- After-hours call centers are crucial for pediatric care access.
- Assessing compliance and outcomes of nurse-led triage is vital for quality improvement.
Purpose of the Study:
- To evaluate compliance with nurse disposition recommendations from a pediatric after-hours call center.
- To determine the frequency of death or potential underreferral after triage.
- To identify factors associated with potential underreferral in pediatric patients.
Main Methods:
- Retrospective analysis of 32,968 pediatric calls to an after-hours call center (1999-2003).
- Categorization of disposition recommendations: urgent, next day, later visit, home care.
- Calculation of compliance rates and identification of underreferral factors via multivariate modeling.
Main Results:
- High compliance (74%) for urgent and home care recommendations; lower compliance (44%) for next-day recommendations.
- A low rate of potential underreferral (0.2%) with subsequent hospitalization was observed.
- Younger age (<6 weeks or >12 years) and triage after 11 pm were linked to higher underreferral rates.
Conclusions:
- Families generally adhered to urgent and home care advice, but intermediate recommendations had lower compliance.
- The risk of underreferral with hospitalization following after-hours triage is minimal.
- Patient age and call timing are significant factors influencing the need for further medical evaluation.
Objectives:
Our goals were to assess (1) compliance with nurse disposition recommendations, (2) frequency of death or potential underreferral associated with hospitalization within 24 hours after a call, and (3) factors associated with potential underreferral, for children receiving care within an integrated health care delivery organization who were triaged by a pediatric after-hours call center.
Methods:
The study population included all pediatric patients enrolled in Kaiser Permanente Colorado whose families called the Children's Hospital after-hours call center in Denver, Colorado, during the period between October 1, 1999, and March 31, 2003. Postcall disposition recommendations were categorized as urgent (visit within 4 hours), next day (visit in > 4 hours but within 24 hours), later visit (visit in > 24 hours), or home care (care at home without a visit). Compliance with the nurses' triage disposition recommendations was calculated as the proportion of cases for which utilization data matched the disposition recommendations.
Results:
Of the 32,968 eligible calls during the study period, 21% received urgent, 27% next day, 4% later visit, and 48% home care disposition recommendations. Rates of compliance with both urgent and home care disposition recommendations were 74%, and the rate of compliance with next day recommendations was 44%. No deaths occurred within < 1 week after the after-hours calls. The rate of potential underreferral with subsequent hospitalization was 0.2%, or 1 case per 599 triaged calls. In multivariate modeling, age of < 6 weeks or > 12 years and being triaged after 11 pm were associated with higher rates of potential under-referral.
Conclusions:
Approximately three fourths of families complied with recommendations for their child to be evaluated urgently or to be treated at home, with much lower rates of compliance with intermediate dispositions. The rate of potential underreferral with hospitalization was low, and age and time of call triage were associated with this outcome.
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