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  • Title: Outcomes associated with pediatric after-hours care by call centers: a multicenter study.
    Author: Kempe A, Luberti A, Belman S, Hertz A, Sherman H, Amin D, Dempsey C, Chandramouli U, MacKenzie T.
    Journal: Ambul Pediatr; 2003; 3(4):211-7. PubMed ID: 12882599.
    Abstract:
    OBJECTIVES: To assess 1) parental opinion regarding appropriateness of triage, 2) utilization outcomes, and 3) the frequency of underreferral with subsequent hospitalization for children triaged by nurses at pediatric call centers. DESIGN/METHODS: From August 19 to October 1999, after-hours calls were randomly sampled from computerized records at 4 call centers at children's hospitals. Telephone surveys were conducted 3 to 7 days after the index calls. An expert panel to assess appropriateness of disposition reviewed audio recordings of calls given a nonurgent disposition and then hospitalized within 24 hours. RESULTS: Surveys were completed for 70.5% (N = 1561). Parental agreement with urgent or home care recommendations was >70% but with intermediary recommendations was <50%. Hospitalizations were more common among children urgently referred (4.6% vs 0.45%; P =.0003). Calls judged urgent by call center nurses and referred to a physician for secondary triage had lower rates of urgent visits (odds ratio [OR] 0.58; 95% confidence interval [CI] 0.53-0.65; P <.0001) and higher rates of never having a visit (OR 1.37; 95% CI 1.24-1.51; P <.0001) than those referred directly by nurses. The weighted rate of underreferral with hospitalization was 0.3% (95% CI 0.1-0.7%) or 1 in 481 calls (95% CI 1/152 to 1/1538). CONCLUSIONS: Our data demonstrate an underreferral rate with subsequent hospitalization of 1 in 500 calls and a significant reduction in visits when those cases judged urgent by call center nurses undergo secondary triage by physicians.
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