title: Caller satisfaction with after-hours telephone advice: nurse advice service versus on-call pediatricians.
abstract: OBJECTIVE
  To compare caller satisfaction with after-hours medical advice provided by a for-profit nurse advice service with advice provided by on-call pediatricians.
  
  
  METHODS
  The study setting was the general pediatrics faculty practice of an urban university medical center. Participants were parents or guardians of a population of approximately 6000 children calling for after-hours medical advice over a 10-month period from January 18 to November 20, 2000. After-hours medical advice calls were randomized to either a nurse advice service or the on-call pediatrician. Caller satisfaction and subsequent health care utilization were measured by a telephone survey of callers and review of all health care visits within 3 days of the initial telephone advice call.
  
  
  RESULTS
  Five hundred sixty-six (48%) callers were enrolled in the on-call pediatrician group, and 616 (52%) were enrolled in the advice nurse group. Caller satisfaction was rated as very good or excellent significantly more often for the on-call pediatrician than for the nurse advice service as follows: telephone call overall (68.5% vs 55.0%; 95% confidence interval [CI] of difference: 8.0%-19.0%), thoroughness and competence of the person they spoke with (74.0% vs 59.1%; 95% CI of difference: 9.6%-20.2%), courtesy and friendliness of the person they spoke with (77.4% vs 73.9%; 95% CI of difference: -1.4%-8.4%), length of time spent waiting (70.8% vs 60.1%; 95% CI of difference: 5.4%-16.2%), time spent talking with the on-call pediatrician or advice nurse (68.2% vs 52.4%; 95% CI of difference: 10.2%-21.3%), and the medical advice given (68.6% vs 53.9%; 95% CI of difference: 9.2%-20.1%). Compliance with the advice given was significantly higher for office care in the on-call pediatrician group (51.5% vs 29.6%; 95% CI of difference: 8.9%-34.2%). Repeat calls for advice were significantly more frequent for the nurse advice service, both within 4 hours (13.0% vs 4.8%; 95% CI of difference: 5.0%-11.4%), and within 72 hours (23.4% vs 13.3%; 95% CI of difference: 5.8%-14.5%).
  
  
  CONCLUSIONS
  Callers were less satisfied with medical advice provided by a nurse advice service compared with the traditional on-call pediatrician. The lower satisfaction was associated with somewhat poorer compliance with recommended triage dispositions and more frequent repeat calls for medical advice.
authors.affiliation: Emergency Medicine Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Lee
authors.forename: Judith
authors.initials: J
authors.lastname: Guzy
authors.forename: David
authors.initials: D
authors.lastname: Johnson
authors.forename: Heide
authors.initials: H
authors.lastname: Woo
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Baraff
mesh_terms: D002648:Child; D003153:Community Health Services; D003258:Consumer Behavior; D015277:Hotlines / Q000592:standards*; D006801:Humans; D010371:Pediatric Nursing / Q000379:methods*; D010372:Pediatrics / Q000379:methods*; D019114:Remote Consultation; D014218:Triage