Published online June 1, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. 1139-1144 (doi:10.1542/peds.2006-1986)
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ARTICLE

The Host Hospital 24-Hour Underreferral Rate: An Automated Measure of Call-Center Safety

Daniel A. Hirsh, MDa,b,c, Harold K. Simon, MD, MBAa,b,c, Robert Masseyd, Lisa Thornton, RNe and Joseph E. Simon, MS, MDc,e

a Departments of Pediatrics
b Emergency Medicine, Emory University, Atlanta, Georgia
c Departments of Pediatrics
d Information Systems and Technology
e Emergency Services, Children's Healthcare of Atlanta, Atlanta, Georgia

OBJECTIVES. The goals were to (1) define and illustrate an automated method of monitoring the safety of telephone triage, (2) demonstrate that this method approximates reasonably a more-global safety measure, and (3) describe the month-to-month variability of this automated measure for the call center studied.

METHODS. From October 2005 through March 2006, hospitalizations at a tertiary care pediatric hospital after calls to its call center were matched with their respective call-center dispositions. The host hospital 24-hour underreferral rate was defined as the percentage of total admissions to the study institution within 24 hours after a call to the call center for treatment of the same illness or injury that had been assigned a nonurgent disposition by the call center. A convenience sample of call-center calls was surveyed for admissions to other facilities. This sample was then combined with admissions to the pediatric hospital to estimate a true 24-hour underreferral rate. Underreferrals were subjected to clinical and statistical analyses.

RESULTS. The host hospital 24-hour underreferral rate was 5.2%. The estimated true 24-hour underreferral rate was 5.95% ± 2.75%. Diagnoses frequently associated with underreferral were gastroenteritis, croup, asthma, and bronchiolitis. Underreferred patients admitted to the study institution were hospitalized for an average of 1.6 ± 1.1 days, compared with 2.8 ± 3.1 days for patients referred by the call center to a higher level of care. The monthly SD of the host hospital 24-hour underreferral rate was 1.56%.

CONCLUSIONS. For the call center studied, the host hospital 24-hour underreferral rate could be determined easily and objectively and approximated reasonably the true 24-hour underreferral rate. The month-to-month variability of the host hospital 24-hour underreferral rate was sufficiently small to allow for meaningful internal trending analyses.

Key Words: call center • telephone medicine • telephone triage • pediatrics • patient safety

Abbreviations: CC—call center • ED—emergency department • AHC—after-hours care • CI—confidence interval

Accepted Jan 18, 2007.