Medical Advice OK from After-Hours Call Centers

NEW YORK – People with concerns about their kids’ health and who call their doctor after hours may find themselves speaking to a call center operator. Reassuringly, the advice they get seems to be safe and reliable, according to a new study published in the medical journal Pediatrics.

"In the past decade, the delivery of health care after office hours has undergone profound changes," Dr. Allison Kempe, of Children’s Hospital, Denver, Colorado, and colleagues write. "Many primary care providers have stopped taking after-hours calls themselves, instead signing out to centralized call centers that manage patient calls regarding acute problems for multiple health care providers."

To evaluate the performance a pediatric after-hours call center, the team assessed the frequency of adverse events (including death) or potential under-referral with subsequent hospitalization.

Included in the analysis were all children enrolled in Kaiser Permanente Colorado whose families had contacted the Children’s Hospital after-hours call center between 1999 and 2003.

A total of nearly 33,000 calls were made during the study period. Of these, 21 percent were advised to seek urgent care, 27 percent were advised to seek care the next day, 4 percent were advised to seek care within 72 hours, and 48 percent were advised to treat their children at home.

From the records, the researchers saw that compliance rates were 74 percent for both urgent care and home care disposition recommendations. Only 44 percent of callers complied with advice to seek care the next day.

Five patients died during the study period, and only one instance occurred within a month of the initial call.

The rate of potential under-referral leading to hospitalization was only 0.2 percent, or one case per 599 calls.

"Our findings support the safety of triage by call centers with respect to short-term adverse outcomes such as hospitalization," Kempe’s team concludes.

SOURCE: Pediatrics, August 2006.