High-risk obstetrical call center vs. healthcare providers: is there consistency in advice given?

To determine the level of agreement between the advice given to an obstetric patient calling an obstetric call center and the advice given by health care providers with varying degrees of knowledge and experience.

This is a retrospective quality improvement project which evaluates the level of agreement between advice from nurses at an obstetric call center using software with obstetric triage protocols compared with advice given by women's health advanced practice nurse (APN), a fourth year obstetrics and gynecology (OB-GYN) resident, and a maternal fetal medicine (MFM) specialist on the same call scenarios.

The call center nurses advised emergency care more frequently (51.7%) than the MFM (44%) and the APN (31.9%) but less frequently than the OB-GYN resident (57.1%). The levels of agreement between the call center nurse and the MFM were good (κ = 0.71; 95% CI: 0.57-0.85). The levels of agreement between the call center nurses and the resident and APN were considered moderate with κ = 0.60 (95% CI: 0.42-0.77) and κ = 0.60 (95% CI: 0.45-0.76).

Advice given by nurses at an obstetric call center was highly consistent with the most skilled specialist (MFM) followed closely by OB-GYN resident or an APN.