title: The host hospital 24-hour underreferral rate: an automated measure of call-center safety.
abstract: OBJECTIVE
  The goals were to (1) define and illustrate an automated method of monitoring the safety of telephone triage, (2) demonstrate that this method approximates reasonably a more-global safety measure, and (3) describe the month-to-month variability of this automated measure for the call center studied.
  
  
  METHODS
  From October 2005 through March 2006, hospitalizations at a tertiary care pediatric hospital after calls to its call center were matched with their respective call-center dispositions. The host hospital 24-hour underreferral rate was defined as the percentage of total admissions to the study institution within 24 hours after a call to the call center for treatment of the same illness or injury that had been assigned a nonurgent disposition by the call center. A convenience sample of call-center calls was surveyed for admissions to other facilities. This sample was then combined with admissions to the pediatric hospital to estimate a true 24-hour underreferral rate. Underreferrals were subjected to clinical and statistical analyses.
  
  
  RESULTS
  The host hospital 24-hour underreferral rate was 5.2%. The estimated true 24-hour underreferral rate was 5.95% +/- 2.75%. Diagnoses frequently associated with underreferral were gastroenteritis, croup, asthma, and bronchiolitis. Underreferred patients admitted to the study institution were hospitalized for an average of 1.6 +/- 1.1 days, compared with 2.8 +/- 3.1 days for patients referred by the call center to a higher level of care. The monthly SD of the host hospital 24-hour underreferral rate was 1.56%.
  
  
  CONCLUSIONS
  For the call center studied, the host hospital 24-hour underreferral rate could be determined easily and objectively and approximated reasonably the true 24-hour underreferral rate. The month-to-month variability of the host hospital 24-hour underreferral rate was sufficiently small to allow for meaningful internal trending analyses.
authors.affiliation: Department of Pediatrics, Emory University, Atlanta, Georgia, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hirsh
authors.forename: Harold K
authors.initials: HK
authors.lastname: Simon
authors.forename: Robert
authors.initials: R
authors.lastname: Massey
authors.forename: Lisa
authors.initials: L
authors.lastname: Thornton
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Simon
mesh_terms: D039602:After-Hours Care / Q000379:methods / Q000639:trends; D002648:Child; D006776:Hospitals, Pediatric / Q000639:trends; D015277:Hotlines; D006801:Humans; D007253:Information Centers / Q000639:trends; D012017:Referral and Consultation; D012449:Safety; D013689:Telephone; D014218:Triage / Q000379:methods / Q000639:trends