After-Hours Telephone Coverage: The Application of an Area-Wide Telephone Triage and Advice System for Pediatric Practices

PEDIATRICS ◽  
1993 ◽  
Vol 92 (5) ◽  
pp. 670-679 ◽  
Author(s):  
Steven R. Poole ◽  
Barton D. Schmitt ◽  
Thea Carruth ◽  
Ann Peterson-Smith ◽  
Minnie Slusarski
Keyword(s):  
Home Care ◽  
Patient Care ◽  
Large Scale ◽  
Time Of Day ◽  
Physician Satisfaction ◽  
Telephone Triage ◽  
Total Cost ◽  
Phone Calls ◽  
After Hours ◽  
Telephone Calls

Background. After-hours telephone calls are a stressful and frustrating aspect of pediatric practice. At the request of private practice pediatricians in Denver, a metropolitan area-wide system was created to manage after-hours pediatric telephone calls and after-hours patient care. This system, the After-Hours Program (AHP), uses specially trained pediatric nurses with standardized protocols to provide after-hours telephone triage and advice for the patients of 92 Denver pediatricians, representing 56 practices. Objectives. This report describes the AHP, presents data from 4 years' experience with the program, and describes results of our evaluation of the following aspects of the program: subscribing physician satisfaction, parent satisfaction, the accuracy and appropriateness of telephone triage, and program costs. Methods. After-Hours Program records (including quality assurance data) for all 4 years of operation were retrospectively reviewed, tabulated, and analyzed. The results of two subscribing physician surveys and one parent caller satisfaction survey are presented. A retrospective review of after-hours patient care encounter forms assessed the necessity for after-hours visits triaged by the AHP. An analysis of the total cost of this program to 10 randomly selected subscribing physicians was conducted using current AHP data and a survey of the 10 physicians. Results. In 4 years, 107 938 calls have been successfully managed without an adverse clinical outcome. Minor errors in using protocols occurred in one call out of 1450 after-hours calls. After-hours phone calls necessitated an after-hours patient visit 20% of the time and generated one after-hours hospital admission out of every 88 calls. Just over half of the patients were managed with home care advice only, and 28% were given home care advice after-hours and seen the next day in the primary physician's office. Of all patients directed by the telephone triage nurses to be seen after hours, 78% were determined to have a condition necessitating after-hours care. Data are presented regarding call volumes by time of day, day of week, patient age, and patient's initial complaint. The 6 most common complaints accounted for more than one half of the calls, and 38 complaints accounted for more than 95% of all after-hours calls. Utilization by subscribing physicians is described. Satisfaction among subscribing pediatricians was 100%, and among parents was 96% to 99% on a variety of issues. The total cost to participating Denver pediatricians (which includes revenues "given up" as a result of not seeing patients after hours) ranged from 1% to 12% of their annual net income, depending on a variety of factors. Conclusions. Large-scale after-hours telephone coverage systems can be effective and well-received by patients, parents, and primary physicians. Data presented in this report can assist in planning the training of personnel who provide after-hours telephone advice and triage. Controversies associated with this type of program are discussed. Suggestions are made regarding the direction of future programs and research.

scholarly journals P004: Effect of telephone triage (811) calls on a regional poison centre

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S64
Author(s):  
S. Alrobaian ◽  
K. Hurley ◽  
E. Fitzpatrick ◽  
L. Mosher ◽  
M. Young ◽  
...  
Keyword(s):  
Care Facility ◽  
Time Of Day ◽  
Categorical Variables ◽  
Future Research ◽  
Telephone Triage ◽  
Poison Centre ◽  
Phone Calls ◽  
The Impact ◽  
Watson Statistic ◽  
Call Volume

Introduction: Telephone Triage Services (TTS) manage phone calls from the public regarding general medical problems and provide telephone advice. This telephone based care can overlap with care provided by Poison Centres. Our objective was to examine the impact of a provincial 811 TTS on the IWK Regional Poison Centre (RPC). Methods: This is a retrospective descriptive study using interrupted time series methodology. We compared monthly IWK RPC call volume in the pre-811 era (January 2007-July 2009) and the post-811 era (September 2009-December 2017). We summarized the characteristics of callers who accessed the IWK RPC in terms of client age, sex, intentionality, time of day, call disposition and outcome. Caller characteristics were compared between the pre- and post-811 eras using chi-square test for categorical variables. We used segmented regression analysis to evaluate changes in slope of call volume in the pre- and post 811 eras. The Durbin-Watson statistic was performed to test for serial correlation and the Dickey-Fuller test to investigate seasonality. Results: The dataset included 82683 calls to the IWK RPC – 27028 pre-811 and 55655 post-811. Overall, 55% of calls were for female clients and the largest age group was children aged 0-5 years (37%). Most calls originated from home (47%), followed by a health care facility (23%). Most calls were managed at home (65%). Less than 3% of calls resulted in major effect or death. The Durbin Watson statistic was not statistically significant (p = 0.94). The Dickey-Fuller test indicated series stationarity (p = 0.001). There was no statistically significant change in call volume to the IWK RPC due to the introduction of 811 (p = 0.39). There was no significant variation by time of day, day of week or month, with most calls occurring in the evening. There were significantly more calls regarding intentional ingestions in the post-811 era (23% vs. 19% pre-811, p < .001). Outcomes in the pre and post 811 eras were as follows: minor/no effect/non-toxic/minimal 80% vs. 78%; moderate 7% vs. 10%; and, major/death 1.7% vs. 2.0%. Conclusion: The introduction of a TTS did not change call volumes at our RPC. The increase in the percentage of calls about intentional ingestions may reflect an increase in call acuity as the 811-TTS likely manages calls about minor/non-toxic ingestions without consulting with the RPC. Our future research will examine the nature of poison related calls to the 811-TTS.

Are You Interested in Telephone Triage Research?

PEDIATRICS ◽  
1995 ◽  
Vol 95 (5) ◽  
pp. 802-802
Author(s):  
Steven R. Poole
Keyword(s):  
Large Scale ◽  
Telephone Triage ◽  
The Past ◽  
After Hours

In the fall of 1993, we described our 5-year experience in providing after-hours telephone triage and advice for patients of private pediatricians in metropolitan Denver (The After-Hours Program).1 In the year since our report, we have come to recognize a rapidly growing interest in large scale programs that offer centralized after-hours pediatric telephone triage and advice provided by well-trained nurses using standardized guidelines. In the past year our program has expanded to serve approximately 165 pediatricians throughout Colorado (95% of Denver private pediatricians and 75% of Colorado private pediatricians).

scholarly journals Fine-grained dengue forecasting using telephone triage services

2016 ◽  
Vol 2 (7) ◽  
pp. e1501215 ◽  
Author(s):  
Nabeel Abdur Rehman ◽  
Shankar Kalyanaraman ◽  
Talal Ahmad ◽  
Fahad Pervaiz ◽  
Umar Saif ◽  
...  
Keyword(s):  
Public Health ◽  
Disease Surveillance ◽  
Large Scale ◽  
Volume Data ◽  
Telephone Triage ◽  
Fine Grained ◽  
The Past ◽  
Phone Calls ◽  
Public Health Officials ◽  
Forecasting System

Thousands of lives are lost every year in developing countries for failing to detect epidemics early because of the lack of real-time disease surveillance data. We present results from a large-scale deployment of a telephone triage service as a basis for dengue forecasting in Pakistan. Our system uses statistical analysis of dengue-related phone calls to accurately forecast suspected dengue cases 2 to 3 weeks ahead of time at a subcity level (correlation of up to 0.93). Our system has been operational at scale in Pakistan for the past 3 years and has received more than 300,000 phone calls. The predictions from our system are widely disseminated to public health officials and form a critical part of active government strategies for dengue containment. Our work is the first to demonstrate, with significant empirical evidence, that an accurate, location-specific disease forecasting system can be built using analysis of call volume data from a public health hotline.

Occupational Exposures in the Homecare Environment: Piloting an Observation Tool

2021 ◽  
pp. 108482232098691
Author(s):  
Elizabeth Bien ◽  
Kermit Davis ◽  
Susan Reutman ◽  
Gordon Gillespie
Keyword(s):  
Home Care ◽  
Patient Care ◽  
Occupational Safety ◽  
Occupational Exposures ◽  
Care Patient ◽  
Home Healthcare ◽  
Occupational Hazards ◽  
Cross Sectional ◽  
Direct Observations ◽  
Occupational Setting

The population of home healthcare workers (HHCWs) is rapidly expanding. Worker tasks and the unique home care environments place the worker at increased risks of occupational exposures, injury, and illness. Previous studies focusing on occupational exposures of HHCWs are limited to self-reports and would benefit from direct observations. The purpose of this study is to describe the occupational hazards observed in the unique work environment of home healthcare. HHCWs and home care patient participants were recruited from one home care agency in the Midwest to be observed during a routine home visit. This cross-sectional study used a trained occupational health nurse for direct observation of the occupational setting. Standardized observations and data collection were completed using the Home Healthcare Worker Observation Tool. The observer followed a registered nurse and occupational therapist into 9 patient homes observing visits ranging from 22 to 58 minutes. Hazards observed outside of and within the home include uneven pavements (n = 6, 67%), stairs without railings (n = 2, 22%), throw rugs (n = 7, 78%), unrestrained animals (n = 2, 22%), dust (n = 5, 56%), and mold (n = 2, 22%). Hand hygiene was observed prior to patient care 2 times (22%) and after patient care during 5 visits (56%). Observations have identified hazards that have the potential to impact workers’ and patients’ health. The direct observations of HHCWs provided opportunities for occupational safety professionals to understand the occupational exposures and challenges HHCWs encounter in the home care environment and begin to identify ways to mitigate occupational hazards.

WED 027 Acute neurology in glasgow

2018 ◽  
Vol 89 (10) ◽  
pp. A4.4-A4
Author(s):  
Brennan M ◽  
Tyagi A ◽  
Leach JP
Keyword(s):  
Patient Care ◽  
University Hospital ◽  
Phone Calls ◽  
Neurological Illness ◽  
Medical Inpatients ◽  
Medical Wards

Provision of acute liaison in-patient neurology reduces demand on neurology out patient services, reduces unnecessary investigations and use of medical beds by patients waiting on in-patient neurology review and allows speedier access to necessary neurological services for those with a neurological illness.The pressure on acute neurology beds at QEUH Glasgow is immense and there is considerable delay in patients waiting for admission to the ward. An audit of the acute on call service in mid 2015 showed a 100% increase in the number of phone calls received by the on call registrar when compared to a similar audit in 2008. The number of requests for ward visiting to review medical inpatients at the Queen Elizabeth University hospital increased by more than 100% over the previous year.In June 2016 an Acute Neurology rota was introduced whereby a Consultant Neurologist supervised and delivered patient care for the acute neurology wards, referrals from medical wards and acute receiving, as well as twice a week acute neurology clinics. This has led to a significantly improved care for patients referred with neurological problems as perceived by trainees, consultants and referring medical physicians, as evident on a survey carried out in 2017.

Performance of a new guideline for telephone triage in out-of-hours services in Belgium: A pilot study using simulated patients

2020 ◽  
Vol 33 (4) ◽  
pp. 166-171
Author(s):  
Stefan Morreel ◽  
Hilde Philips ◽  
Annelies Colliers ◽  
Veronique Verhoeven
Keyword(s):  
General Practitioner ◽  
Primary Objective ◽  
Phone Call ◽  
Simulated Patients ◽  
Telephone Triage ◽  
Out Of Hours ◽  
Important Variation ◽  
Phone Calls ◽  
The Right ◽  
Urgency Level

Background Patients in Belgium needing out-of-hours care have two options: the emergency department or the general practitioner on call often organised in a general practitioner cooperative. Currently, there is no triage system in Belgium so patients do not know where to go. Methods Our primary objective was to examine the ability of a newly developed telephone guideline, called 1733, to adequately estimate the urgency of health problems presented by simulated patients. Ten clinical vignettes were presented to 12 operators in a simulated phone call. The operators had to assign a protocol, urgency level and resource to dispatch (ambulance, general practitioner house visit, etc.) to each case. Results A total of 120 phone calls were analysed. The operators chose the right protocol in 69% and the correct urgency level in 35% of the cases. The proportion of under- and over-triage was 26% and 39%, respectively. There was important variation in between the operators. The sensitivity for detecting highly urgent cases was 0.42, the specificity 0.92. Conclusion Using the new Belgian 1733 guideline for telephone triage, operators mostly chose the appropriate protocol but only chose the correct urgency in one out of three cases. In this phase of development, the studied telephone guideline is not ready for implementation.

scholarly journals Carbon dioxide fluxes increase from day to night across European streams

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Katrin Attermeyer ◽  
Joan Pere Casas-Ruiz ◽  
Thomas Fuss ◽  
Ada Pastor ◽  
Sophie Cauvy-Fraunié ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Carbon Dioxide Emissions ◽  
Large Scale ◽  
Carbon Dioxide Flux ◽  
Time Of Day ◽  
Night Time ◽  
Carbon Dioxide Fluxes ◽  
Large Scale Assessment ◽  
Air Interface ◽  
Flux Variability

AbstractGlobally, inland waters emit over 2 Pg of carbon per year as carbon dioxide, of which the majority originates from streams and rivers. Despite the global significance of fluvial carbon dioxide emissions, little is known about their diel dynamics. Here we present a large-scale assessment of day- and night-time carbon dioxide fluxes at the water-air interface across 34 European streams. We directly measured fluxes four times between October 2016 and July 2017 using drifting chambers. Median fluxes are 1.4 and 2.1 mmol m−2 h−1 at midday and midnight, respectively, with night fluxes exceeding those during the day by 39%. We attribute diel carbon dioxide flux variability mainly to changes in the water partial pressure of carbon dioxide. However, no consistent drivers could be identified across sites. Our findings highlight widespread day-night changes in fluvial carbon dioxide fluxes and suggest that the time of day greatly influences measured carbon dioxide fluxes across European streams.

Abstract WP95: Feasibility of 24/7 Neurohospitalist Presence and Impact on Alteplase DTN Times and Mortality

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alexander T Schneider ◽  
Reid Taylor ◽  
Robin Jones ◽  
Roy Nanz ◽  
Edward Jauch
Keyword(s):  
Ischemic Stroke ◽  
Intervention Group ◽  
Statistical Correlation ◽  
Time Of Day ◽  
Care Model ◽  
Community Hospitals ◽  
Post Intervention ◽  
Anova Model ◽  
Median Test ◽  
After Hours

Introduction: After hours stroke coverage in community hospitals is typically provided on-call from home or through telehealth. Lack of immediate on-site stroke expertise may delay door-to-needle (DTN) times for IV alteplase. A 750-bed community hospital that had evening emergency stroke coverage by a neurologist on-call from home transitioned to 24/7 neurohospitalist coverage in October 2015. Methods: Data were obtained from patients treated with alteplase in the ED for ischemic stroke. We evaluated the DTN times at baseline and after intervention of the new care model dichotomized by daytime (7a-5p) and evening (5p-7a). Mortality (death in hospital and discharge (DC) to hospice) was assessed. Data were compared for statistical correlation using a Mood’s Median Test and 2-sample t-test. Results: There were 579 cases from January 2015 through July 2019 treated with alteplase in the ED for ischemic stroke. Patients available for study pre- and post-intervention were 84 and 495, respectively (Table 1). Daytime arrival was more common. Significant improvements in door-to-neurohospitalist at bedside and DTN time were observed regardless of time of day, but the greatest difference seen was in evening hours. Using an ANOVA model, EMS arrival was the most significant factor predicting DTN times. Despite fewer patients arriving via EMS in the post-intervention group (90% vs 94% baseline), the DTN times improved post intervention. Mortality was significantly improved after the intervention. Despite a 44% increase in code stroke arrivals to the ED, the feasibility of the care model over ~4 years was maintained by no loss of any neurohospitalists and the addition of 1 more. Conclusion: In-hospital 24/7 model of neurohospitalist coverage is a feasible model for large community hospitals and is associated with significantly faster DTN times and reduced mortality. We will explore other aspects of the care model and other changes occurring during the study period.

scholarly journals Impact of Pharmacy Student–Driven Postdischarge Telephone Calls on Heart Failure Hospital Readmission Rates: A Pilot Program

2018 ◽  
Vol 54 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Roda Plakogiannis ◽  
Ana Mola ◽  
Shreya Sinha ◽  
Abraham Stefanidis ◽  
Hannah Oh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Discharge ◽  
Hospital Readmission ◽  
Pharmacy Students ◽  
Pharmacy Student ◽  
Pilot Program ◽  
Readmission Rates ◽  
Phone Calls ◽  
Hospital Readmission Rates ◽  
Telephone Calls

Background: Heart failure (HF) hospitalization rates have remained high in the past 10 years. Numerous studies have shown significant improvement in HF readmission rates when pharmacists or pharmacy residents conduct postdischarge telephone calls. Objective: The purpose of this retrospective review of a pilot program was to evaluate the impact of pharmacy student–driven postdischarge phone calls on 30- and 90-day hospital readmission rates in patients recently discharged with HF. Methods: A retrospective manual chart review was conducted for all patients who received a telephone call from the pharmacy students. The primary endpoint compared historical readmissions, 30 and 90 days prior to hospital discharge, with 30 and 90 days post discharge readmissions. For the secondary endpoints, historical and postdischarge 30-day and 90-day readmission rates were compared for patients with a primary diagnosis of HF and for patients with a secondary diagnosis of HF. Descriptive statistics were calculated in the form of means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Results: Statistically significant decrease was observed for both the 30-day ( P = .006) and 90-day ( P = .007) readmission periods. Prior to the pharmacy students’ phone calls, the overall group of 131 patients had historical readmission rates of 24.43% within 30 days and 38.17% within 90 days after hospital discharge. After the postdischarge phone calls, the readmission rates decreased to 11.45%, for 30 days, and 22.90%, for 90 days. Conclusion: Postdischarge phone calls, specifically made by pharmacy students, demonstrated a positive impact on reducing HF-associated hospital readmissions, adding to the growing body of evidence of different methods of pharmacy interventions and highlighting the clinical impact pharmacy students may have in transition of care services.

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