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    Pediatric call centers fast-track urgent care

    Call centers using evidence-based protocols ensure that patients receive urgent medical care in the most appropriate, most cost-effective setting.

     

    Compliance rates

    Do parents take the advice of call centers? To determine compliance rates as well as the frequency of underreferrals made by their call center, investigators affiliated with the Children’s Hospital Colorado reviewed more than 32,000 calls received from 1999 to 2003. At that time, recommendations were divided into 4 categories: urgent (visit within 4 hours); next day (>4 hours and within 24 hours); later visit (>24 hours); or home care (no visit). They discovered that compliance with urgent and home care calls was 74%, and compliance with next day recommendations was 44%. No deaths occurred within the week following the triage call and only 1 case per 599 resulted in hospitalization.10 In another study, there was a 90% agreement between ED referrals made by nurses and the ED physicians who evaluated the patients.11

    More: Are you prepared for a clinical emergency?

    Additionally, the goal of the call center at Children’s Hospital Colorado was to achieve 0% ED underreferrals, and to always err on the side of caution and have no higher than a 10% overreferral rate. The only way that has been shown to improve upon call center triage ED referral rates is to have second-level physician triage. Doing so can reduce call center referrals to EDs from about 20% to 10%.12 The reason is that physicians are familiar with patients and parents in their practices and this familiarity can guide recommendations. Frequently, physicians postpone seeing the patient until the next morning.

    Pediatric protocols

    The quality of call centers depends on multiple factors. The training of triage nurses is a key element, as is the accurate logging of calls with recommendations, in addition to ongoing quality assurance making sure that calls are triaged correctly. The call center at Children’s Hospital Colorado has a monthly targeted review as part of its ongoing quality assurance program. All calls are recorded and are available for review. A rotation through the call center is an integral part of the pediatric resident training. The protocols are evidence based, reflect current opinion of experts in pediatric care, follow current national guidelines, and are reviewed and updated every year. Since it opened in 1988, the call center has logged over 2 million calls, and there have been no adverse outcomes during this time.

    NEXT: Contemporary call centers

    Andrew J Schuman, MD, FAAP
    Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, ...
    Barton D. Schmitt, MD
    Dr. Schmitt is professor of pediatrics, University of Colorado School of Medicine, and Director of General Consultative Services, The ...

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