title: Outcomes of children referred to an emergency department by an after-hours call center.
abstract: OBJECTIVE
  After-hours call centers are increasingly prevalent, yet there is little patient outcomes data. We sought to determine compliance with referral to an emergency department (ED) and describe outcomes and clinical characteristics of referred patients including triage classifications, therapeutic interventions, diagnostic testing, diagnoses, and hospitalization rates.
  
  
  METHODS
  A retrospective cohort design. We studied hospital-based primary care patients who were referred to the ED of a tertiary care children's hospital by the call center, without physician consultation.
  
  
  RESULTS
  Of the 8265 telephone calls to the call center, 1473 (18%) children were referred to the ED, and 931 (63%) were compliant. Compliant patients were significantly younger (P = 0.01) and were more likely to have been referred to the ED immediately (P = 0.01) compared with noncompliant patients. Among compliant patients, 48% were classified as nonurgent at ED triage; of these, half did not have a therapeutic intervention or diagnostic test or require hospitalization. Overall, therapeutic interventions were administered to 44%, diagnostic tests were performed for 45%, and 13% were hospitalized. Compared to children referred immediately to the ED, the proportion instructed to go to the ED within 4 hours of the telephone call received significantly lower ED triage classifications (93% vs. 77%, P < 0.00001) and hospitalizations (15% vs. 6%, P = 0.001).
  
  
  CONCLUSIONS
  In this study, we report the outcomes and clinical characteristics of children referred to the ED by an after-hours call center. Data such as these may be used by call centers in the assessment of management advice and referral practices.
authors.affiliation: Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. Scarfone@email.chop.edu
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Scarfone
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Luberti
authors.forename: Rakesh D
authors.initials: RD
authors.lastname: Mistry
mesh_terms: D039602:After-Hours Care / Q000458:organization & administration; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012017:Referral and Consultation; D013689:Telephone; D014505:Urban Population