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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.


    Contemporary call centers

    As of 2016, there were over 400 call centers using the Smith-Thompson Clinical Content (STCC) protocols with over 20 million calls logged every year.

    Canada has a provincial call center system. Many hospitals have their own call center, and many children’s hospitals nationwide provide nurse triage services. There are independent call centers, and some health insurers provide call center services.

    Providers should be aware that call center services are not created equal. Many centers that provide triage for pediatric patients do not employ pediatric nurses. Call centers usually charge less than $1 per minute, with most calls lasting less than 10 minutes. Many integrated health systems facilitate patient scheduling so nurses can access physician office schedules, and many hospitals are expanding their services to proactively counsel patients discharged from the hospital to reduce readmission rates.

    Next: Is patient satisfaction a good way of measuring quality of care?

    Call center usage is changing (see Table). Tech-savvy parents and patients use multiple resources to self-triage. Call centers can review videos and images sent by patients and routinely send e-mail instructions to facilitate compliance. It has been shown that access to a parent advice book can substantially reduce calls to triage services. In 1 study, distribution of a parent advice book reduced sick visits to health maintenance organization (HMO)-affiliated medical practices by 23%, nurse advice calls by 24%, and prescriptions by 26%.13 When a healthcare system distributed and promoted the use of a triage app to its members in 2013, ED utilization dropped by 39%.14

    What the future holds

    In the opinion of the authors, call centers will continue to evolve. Triage will eventually employ telehealth video technology to improve triage accuracy as well as compliance. It is also possible to recruit call centers to assist with care coordination of children with chronic or complex diseases. In addition, nurses or medical assistants, working out of a call center, can assist with many of the chores that overburden physicians today (prior authorizations, requests for routine forms/letters, and more), reducing burnout rates while facilitating access to an “integrated medical home.”

    Keep watching this space because next month’s Peds v2.0 will discuss how you can use your office triage system to improve efficiency.



    1. Strasser PH, Levy JC, Lamb GA, Rosekrans J. Controlled clinical trial of pediatric telephone protocols. Pediatrics. 1979;64(5):553-557.

    2. Levy JC, Rosekrans J, Lamb GA, Friedman M, Kaplan D, Strasser P. Development and field testing of protocols for the management of pediatric telephone calls: protocols for pediatric telephone calls. Pediatrics. 1979;64(5):558-563.

    3. Fosarelli P, Schmitt B. Telephone dissatisfaction in pediatric practice: Denver and Baltimore. Pediatrics. 1987;80(1):28-31.

    4. Schmitt BD. Pediatric Telephone Advice: Guidelines for the Health Care Provided on Telephone Triage and Office Management of Common Childhood Symptoms. Boston, MA: Little Brown & Co; 1980.

    5. Poole SR, Schmitt BD, Carruth T, Peterson-Smith A, Slusarski M. After-hours telephone coverage: the application of an area-wide telephone triage and advice system for pediatric practices. Pediatrics. 1993;92(5):670-679.

    6. Belman S, Chandramouli V, Schmitt B, Polle SR, Hegarty T, Kempe A. An assessment of pediatric after-hours telephone care: a 1-year experience. Arch Pediatr Adolesc Med. 2005;159(2):145-149.

    7. New England Healthcare Institute (NEHI). How Many More Studies Will It Take? A Collection of Evidence That Our Health Care System Can Do Better. Cambridge, MA: New England Healthcare Institute (NEHI); 2008. Available at: http://www.nehi.net/writable/publication_files/file/how_many_more_studies_will_it_take_introduction.pdf. Accessed March 13, 2017. 

    8. Martsolf G, Fingar KR, Coffey R, et al. Association between the opening of retail clinics and low-acuity emergency department visits. Ann Emerg Med. November 4, 2016. Epub ahead of print.

    9. Bunik M, Glazner JE, Chandramouli V, Emsermann CB, Hegarty T, Kempe A. Pediatric telephone call centers: how do they affect health care use and costs? Pediatrics. 2007;119(2):e305-e313.

    10. Kempe A, Bunik M, Ellis J, et al. How safe is triage by an after-hours telephone call center? Pediatrics. 2006;118(2):457-463.

    11. Kempe A, Dempsey C, Whitefield J, Bothner J, MacKenzie T, Poole A. Appropriateness of urgent referrals by nurses at a hospital-based pediatric call center. Arch Pediatr Adolesc Med. 2000;154(4):355-360.

    12. Kempe A, Dempsey C, Hegarty T, Frei N, Chandramouli V, Poole SR. Reducing after-hours referrals by an after-hours call center with second-level physician triage. Pediatrics. 2000;106(1 pt 2):226-230.

    13. France EK, Selna MJ, Lyons EE, Beck AL, Calonge BN. Effect of a pediatric self-care book on utilization of services in a group model HMO. Clin Pediatr (Phila). 1999;38(12);709-715.

    14. Krames StayWell. Physicians Plus Insurance: Growing a health care brand with mobile engagement. Newsletter. Published February 2013.

    15. Schmitt BD. Pediatric Telephone Protocols: Office Version. 15th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2016.

    16. Thompson DA. Adult Telephone Protocols: Office Version. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012.


    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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