Appropriateness of Urgent Referrals by Nurses at a Hospital-Based Pediatric Call Center

Kempe, Allison; Dempsey, Catherine; Whitefield, Julie; Bothner, Joan; MacKenzie, Todd A.; Poole, Steven R.

doi:10.1001/archpedi.154.4.355

Cited by 48 publications

(52 citation statements)

References 35 publications

(21 reference statements)

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“…116 Most studies reported that a high proportion of referrals, often in excess of 90%, were appropriate. 131,140 Triage advice and referrals were more likely to be unnecessary than insufficient. 142 However, one study identified that acute and non-urgent scenarios were more likely to be classified correctly than urgent.…”

Section: Service Impactsmentioning

confidence: 99%

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What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.

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Section: Service Impactsmentioning

confidence: 99%

“…Of the 15 other studies, 72,89,100,101,[115][116][117][118][119]124,131,135,[138][139][140] four studies looked at the appropriateness of ED referrals. In terms of referral sources, no difference was found between telephone and self-referred patients, 118 but doctor-referred patients were the most appropriate referrals.…”

Section: Service Impactsmentioning

confidence: 99%

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

View full text Add to dashboard Cite

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“…(8) This active preparation for the telenurses' questions appeared to calm the parents and decrease their worry.…”

Section: Preparation For Telenurse's Questionsmentioning

confidence: 99%

“…as to whether pediatric health calls are safe [8][9][10] or not [11] . Moreover, parents have reported both high [12,13] and low [14] satisfaction with the telephone service.…”

mentioning

confidence: 99%

‘If I didn’t trust Swedish Healthcare Direct, I would never call’ – views of making pediatric health calls

Kaminsky

Carlsson²,

Röing³

et al. 2013

Clinical Nursing Studies

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The focus of the presented research is parents' expectations and experiences of calling Swedish Healthcare Direct (SHD) regarding pediatric health issues. Telenursing is a rapidly expanding service and SHD handles up to 2.4 million pediatric health calls yearly. Mothers make the majority of the calls and reportedly receive self-care advice more than fathers. Parents' views are important for the development and safe use of telenursing health services. The study is qualitative, with an exploratory and descriptive design. Twenty-one interviews with parents were analysed using content analysis. According to the interviewees, the decision to contact SHD or not is influenced by their degree of worry or trust in the service. Calls are carefully prepared, and who will call is often predetermined and affected by gender. Parents want to be given a chance to speak first in their communication with telenurses. They want to be listened to carefully and to be accorded respect, to have their needs fully explored and to have their concerns relieved. Most parents follow telenurses' recommendations, a few exclusively. Some primarily trust their own intuition. Learning is frequent, implying the public health potential of calls, not least for foreign-born callers. Exploring parents' expectations provides insight into parents' worries, potential to increase parents' learning and may develop their trust in telenurses' recommendations. Telenurses' awareness of gender impact can further develop the telenursing health service in providing safe care on equal terms for a vulnerable patient group, children.

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“…6,7 The definition of a chronic condition was defined by a question from the Consumer Assessment of Health Plans Survey and included conditions that had lasted for at * Information presented is for entire call center; data in this study based on Denver Metro Area (number of MDs ϭ 153; number of providers ϭ 53; number of counties served ϭ 5; number of calls for winter ϭ 1509; number of calls for summer ϭ 1158; and number of calls for study period ϭ 1197). ** %2LT is the percentage that seems to be urgent per protocol and are referred, at the private physician's request, to the office's on-call physician for second level triage (2LT).…”

Section: Telephone Surveymentioning

confidence: 99%

Delivery of Pediatric After-Hours Care by Call Centers: A Multicenter Study of Parental Perceptions and Compliance

et al. 2001

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ABSTRACT. Background. Despite the rapid growth of centralized call centers to provide after-hours triage to patients of multiple providers, little is known about the perceptions of parents regarding this type of care and their compliance with triage disposition recommendations.Design/Methods. From August through September 1999, randomized samples of after-hours calls were selected each day from computerized records at 4 pediatric call centers at 1) Children's Hospital, Denver, Colorado; 2) Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; 3) Rainbow Babies and Children's Hospital, Cleveland, Ohio; and 4) All Children's Hospital, St Petersburg, Florida. All participating call centers use the same triage software. Calls were randomly selected to yield at least 250 callers with nonurgent dispositions and 100 with urgent dispositions from each site. Telephone surveys to callers were conducted by an external survey unit 3 to 7 days after the call to the call center.Results. Surveys were completed for 70.5% of those sampled (N ‫؍‬ 1561). Parents indicated they were very satisfied or satisfied with aspects of care received from 92.6% (waiting time) to 99.4% (nurse courteousness) of the time. Satisfaction did not differ by site or by recommended disposition of the index call. Most parents (65.2%) reported no preference about speaking with a physician or nonphysician for after-hours care, whereas 27.7% preferred to speak with a physician. Usually speaking with a physician during office hours (odds ratio [OR]: 1.48), feeling it was important that provider knows child's medical history (OR: 3.47), and respondent having an educational level of college graduate or higher (OR: 1.30) were significant predictors of preferring to speak with a physician. Of the 37.0% (N ‫؍‬ 723) of parents who reported any change in their relationship with their primary provider as a result of the after-hours call center, 95.7% (N ‫؍‬ 691) assessed the change to be positive. Reported compliance with the call center disposition recommendation was 83.3% for urgent referral, 41.0% for next day, 4.5% for visit at a later time, and 78.2% for home care. The major reason given by parents for noncompliance was reporting that they heard a different disposition (76.9% for urgent to 100% for visit at a later time).Conclusions. Parental satisfaction with pediatric call centers was uniformly high in 4 different geographic locations, and almost all parents who reported any effect on their relationship with their primary provider assessed it as positive. Compliance with recommendations for urgent evaluation or home care was relatively high but for intermediary dispositions was low. In most cases in which noncompliance occurred, parents reported hearing a different disposition. Additional study is needed to clarify whether noncompliance, especially in cases in which an urgent recommendations was made, is attributable to poor nurse communication of the recommended disposition, parental misinterpretation, or parental difference of opinion. Pediatric...

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Appropriateness of Urgent Referrals by Nurses at a Hospital-Based Pediatric Call Center

Cited by 48 publications

References 35 publications

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

‘If I didn’t trust Swedish Healthcare Direct, I would never call’ – views of making pediatric health calls

Delivery of Pediatric After-Hours Care by Call Centers: A Multicenter Study of Parental Perceptions and Compliance

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