Pediatric telephone call centers: how do they affect health care use and costs?
OBJECTIVE
After-hours call centers have been shown to provide appropriate triage with high levels of parental and provider satisfaction. However, few data are available on the costs and outcomes of call centers from the perspective of the health care system. With this study we sought to determine these outcomes.


METHODS
Parents who called the Pediatric After-hours Call Center at the Children's Hospital of Denver from March 19, 2004, to April 19, 2004, were asked an open-ended question before triage: "We would like to know, what you would have done if you could not have called our call center this evening/today?"


RESULTS
The response rate for the survey was 77.8% (N = 8980). Parents reported that they would have (1) gone to an emergency department or urgent care facility (46%), (2) treated the child at home (21%), (3) called a physician's office the next day (12%), (4) asked another person for advice (13%), (5) consulted a written source (2%), or (6) other (7%). Of the 46% of callers who would have sought emergent care, only 13.5% subsequently were given an urgent disposition by the call center. Fifteen percent of cases in which the parents would have stayed at home were given an urgent disposition by nurses. Assuming that all callers followed the advice provided, the estimated savings per call, based on local costs, was 42.61 dollars per call. Savings based on Medical Expenditure Panel Survey national payment data were 56.26 dollars per call.


CONCLUSIONS
Two thirds of the cases in which parents reported initial intent to go to an emergency department or urgent care facility were not deemed urgent by the call center, whereas 15% of calls from parents who intended to stay home were deemed urgent. If call-center triage recommendations were followed in even half of all cases, then these results would translate into substantial cost savings for the health care system.
Bunik
Maya
M
Department of Pediatrics, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA. bunik.maya@tchden.org
Glazner
Judith E
JE
Chandramouli
Vijayalaxmi
V
Emsermann
Caroline Bublitz
CB
Hegarty
Teresa
T
Kempe
Allison
A
D002662:Child Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D003120:Colorado; D003365:Costs and Cost Analysis; D004630:Emergencies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D013689:Telephone / Q000706:statistics & numerical data*; D014218:Triage / Q000379:methods*