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PEDIATRICS Vol. 106 No. 1 Supplement July 2000, pp. 226-230

PRACTICE MANAGEMENT:
Reducing After-Hours Referrals by an After-Hours Call Center With Second-Level Physician Triage

Received Nov 24, 1999; accepted Mar 1, 2000.

Allison Kempe, Catherine Dempsey, Teresa Hegarty, Nicole Frei, Vijayalaxani Chandramouli, and Steven R. Poole

From the Department of Pediatrics and Preventive Medicine and Biometrics, University of Colorado Health Sciences Center and Children's Hospital, Denver, Colorado.

Objectives.  One-third of practices signing-out to The Children's Hospital Call Center in Denver, Colorado, choose to do second-level physician (SLP) triage for calls judged by the Center to require after-hours referral (AHR). We examined: 1) the effect of SLP triage on the rate of AHRs and 2) reasons for physicians' decisions.

Design.  From January 1998 to August 1998 all calls from patients using a 5-member suburban pediatric practice judged by the Call Center to require AHR were referred to the practice's on-call physician who did SLP triage and completed a questionnaire.

Results.  There were 955 eligible calls, 22% (N = 216) of which were initially given an urgent disposition by Call Center nurses. Physician questionnaires were completed for 97% (N = 209). Of patients initially triaged for AHR, 49% (N = 103) were subsequently given an AHR, 17% (N = 35) a next day office referral, and 34% (N = 71) home care and advice. Reasons for not urgently referring included the following: 1) medical problem didn't require urgent evaluation (95%, N = 99); 2) change in the patient's condition; (40% N = 43); 3) prior knowledge of family's ability to evaluate and care for the patient (40%, N = 43); and 4) knowledge of the patient's medical history (18%, N = 19). After SLP triage the overall urgent referral rate was 11%.

Conclusions.  Signing out to a Call Center decreased physicians' after-hours calls by 77% and SLP triage halved the number of urgent after-hours referrals.  Key words:  telephone triage, telephone medicine, call centers.


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