Telephone advice about an infant given by after-hours clinics and emergency departments

Studies have shown that telephone calls for advice constitute a significant portion of the workload of emergency departments in the United States and the United Kingdom. Reviews of the appropriateness of telephone advice given in emergency departments in the United States indicate that the information given is often inadequate or inaccurate. We performed a study to evaluate the telephone advice given in New Zealand.

We identified 30 public hospital emergency departments and 20 private accident and emergency clinics. Twenty-six towns and cities were represented. We telephoned each of them and requested advice about the management of a fictitious febrile infant.

We were given medical advice by 36 of the centres. In the remaining 14 the caller was referred to an oncall duty doctor or general practitioner for further information. In the 36 departments providing advice, the information was given by a doctor in 5 of the cases, by a nurse in 26, and by a receptionist or unidentified respondent in 5. On average, the caller was asked 3.76 questions about the patient before advice was given. Even if a number of questions were asked, correct advice did not necessarily follow. Thirty five of the advice givers requested the age of the infant, but 16 of them gave inadequate advice despite this knowledge. We judged the advice given to be inadequate in 16 of the 36 institutions that provided it. There was no difference in the standard of advice given by private and public institutions.

This study demonstrates that there are deficiencies in the quality of telephone advice given by emergency departments and private accident and emergency clinics in New Zealand.