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Pediatric Telephone Medicine: Principles. Triage and Advice, 2nd Edition
Abstract
When used properly, telephone triage of pediatric patients saves patients (and physicians) time, money, and worry. Improper use can result in unnecessary office visits and patient morbidity. This manual has been designed to mimic the flow of telephoned contacts with a pediatric office but avoids computerized algorithmic style. Common pediatric ailments are discussed using language that can be understood by receptionists and parents.Special attention is given to medical-legal considerations intrinsic to telephone communication.
Patient safety is a persistent problem in telephone triage research; however, studies have not differentiated between clinicians' and non-clinicians' respective safety. Currently, four groups of decision makers perform aspects of telephone triage: clinicians (physicians, nurses), and non-clinicians (emergency medical dispatchers (EMD) and clerical staff). Using studies published between 2002-2012, we applied Donabedian's structure-process-outcome model to examine groups' systems for evidence of system completeness (a minimum measure of structure and quality). We defined system completeness as the presence of a decision maker and four additional components: guidelines, documentation, training, and standards. Defining safety as appropriate referrals (AR) - (right time, right place with the right person), we measured each groups' corresponding AR rate percentages (outcomes). We analyzed each group's respective decision-making process as a safe match to the telephone triage task, based on each group's system structure completeness, process and AR rates (outcome). Studies uniformly noted system component presence: nurses (2-4), physicians (1), EMDs (2), clerical staff (1). Nurses had the highest average appropriate referral (AR) rates (91%), physicians' AR (82% average). Clerical staff had no system and did not perform telephone triage by standard definitions; EMDs may represent the use of the wrong system. Telephone triage appears least safe after hours when decision makers with the least complete systems (physicians, clerical staff) typically manage calls. At minimum, telephone triage decision makers should be clinicians; however, clinicians' safety calls for improvement. With improved training, standards and CDSS quality, the 24/7 clinical call center has potential to represent the national standard.
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Telephone lines are now a widespread way of communication between patients and physicians. Nevertheless opinions about their effectiveness and efficacy are rather inconsistent. Aim of this study is to review medical literature in order to assess how and when telephone lines have been described as a good or a bad way to help health care, looking for different experiences and opinions, reviews and guidelines about the use of telephone as a tool for delivering health care. We compared what we have found, particularly about Diabetes, with our previous experience. Medline from Pub Med from National Library of Medicine has been consulted using "telephone", "hot line" or "hotline" as key words. Among the 20 thousands references found in the literature, 2051 of them we considered relevant. The most frequently recurrent topics concern pediatrics (19.2%), while diabetes is not very frequent (0.6%). Analyzing more in details, we noticed that the application fields ofhotlines are emergency management, secretary tasks, preventive health care, acute episodes and chronic conditions. Different models of telephone help lines and guidelines in training and running help lines have been found as well. Examining diabetes help lines, we noticed that they are mainly used in case of intercurrent illness, doubts about insulin dose, hypoglycemia. Parents of the youngest patients and with the shortest duration of diabetes are the most frequent users, regardless of HbA1c. Most calls came during holy-days and weekend, especially early in the morning or during the night.
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