Outcomes associated with pediatric after-hours care by call centers: a multicenter study.
OBJECTIVE
To assess 1) parental opinion regarding appropriateness of triage, 2) utilization outcomes, and 3) the frequency of underreferral with subsequent hospitalization for children triaged by nurses at pediatric call centers.


METHODS
From August 19 to October 1999, after-hours calls were randomly sampled from computerized records at 4 call centers at children's hospitals. Telephone surveys were conducted 3 to 7 days after the index calls. An expert panel to assess appropriateness of disposition reviewed audio recordings of calls given a nonurgent disposition and then hospitalized within 24 hours.


RESULTS
Surveys were completed for 70.5% (N = 1561). Parental agreement with urgent or home care recommendations was >70% but with intermediary recommendations was <50%. Hospitalizations were more common among children urgently referred (4.6% vs 0.45%; P =.0003). Calls judged urgent by call center nurses and referred to a physician for secondary triage had lower rates of urgent visits (odds ratio [OR] 0.58; 95% confidence interval [CI] 0.53-0.65; P <.0001) and higher rates of never having a visit (OR 1.37; 95% CI 1.24-1.51; P <.0001) than those referred directly by nurses. The weighted rate of underreferral with hospitalization was 0.3% (95% CI 0.1-0.7%) or 1 in 481 calls (95% CI 1/152 to 1/1538).


CONCLUSIONS
Our data demonstrate an underreferral rate with subsequent hospitalization of 1 in 500 calls and a significant reduction in visits when those cases judged urgent by call center nurses undergo secondary triage by physicians.
Kempe
Allison
A
Department of Pediatrics, University of Colorado HSC and Children's Outcomes Research Program, The Children's Hospital, Denver, Colo. 80218, USA. kempe.allison@tchden.org
Luberti
Anthony
A
Belman
Shira
S
Hertz
Andrew
A
Sherman
Hanna
H
Amin
Dipti
D
Dempsey
Catherine
C
Chandramouli
Usha
U
MacKenzie
Todd
T
D039602:After-Hours Care / Q000592:standards*; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D003120:Colorado; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005431:Florida; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric; D015277:Hotlines / Q000592:standards*; D006801:Humans; D007223:Infant; D009819:Office Visits / Q000706:statistics & numerical data; D009820:Ohio; D017063:Outcome Assessment, Health Care; D010290:Parents / Q000523:psychology*; D010372:Pediatrics / Q000592:standards*; D015143:Philadelphia; D015397:Program Evaluation; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013997:Time Factors; D014218:Triage / Q000592:standards*