An expanded emergency service: role of telephone services in the emergency department

The Medical Information Center at The Hospital for Sick Children in Toronto began in March 1977 to improve triage, provide an improved poison information center, improve response to telephone callers seeking medical advice, and establish a telephone consultation service for physicians. It employs specially trained nursing staff and integrates functionally related services. To determine program effectiveness we studied the records of patients triaged, telephone calls to the poison information center, and calls for other medical information, for periods both before and after the center's opening. We analyzed in detail a sample of telephone calls about acute illness, and surveyed parents who had made such calls. Unnecessary emergency visits have decreased; more patients are sent to a walk-in clinic. Use of the poison information center, especially by physicians, has increased, but fewer poisonings are treated in the emergency department or hospitalized. The Medical Information Center telephone service ensures that more children are managed at home rather than (unnecessarily) treated in the emergency department. Most parents express satisfaction with this service. Few physicians have used the telephone consultation service.