Evaluation of an After-Hours Call Center

Doctor, Kaynan; Correa, Kelly; Olympia, Robert P.

doi:10.1097/pec.0000000000000262

Cited by 15 publications

(12 citation statements)

References 17 publications

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“…These concerns exist due to the potentially fatal consequences of underestimating the urgency of a child’s condition, the nonspecific nature of many childhood illnesses, the speed with which children deteriorate, and the lack of face-to-face contact, forcing assessors to depend on caregivers to observe the child, interpret those observations, and communicate them effectively [57,59–61,64]. The safety of CDS software used to triage children over the telephone is unclear, particularly its sensitivity to detect signs of serious illness in children [53,60–62,65–68], although its purpose is to minimize risk by standardization and to reduce assessor autonomy—a factor underlying many incidents [61,62]. …”

Section: Discussionmentioning

confidence: 99%

Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis

et al. 2017

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BackgroundThe UK performs poorly relative to other economically developed countries on numerous indicators of care quality for children. The contribution of iatrogenic harm to these outcomes is unclear. As primary care is the first point of healthcare contact for most children, we sought to investigate the safety of care provided to children in this setting.Methods and FindingsWe undertook a mixed methods investigation of reports of primary care patient safety incidents involving sick children from England and Wales’ National Reporting and Learning System between 1 January 2005 and 1 December 2013. Two reviewers independently selected relevant incident reports meeting prespecified criteria, and then descriptively analyzed these reports to identify the most frequent and harmful incident types. This was followed by an in-depth thematic analysis of a purposive sample of reports to understand the reasons underpinning incidents. Key candidate areas for strengthening primary care provision and reducing the risks of systems failures were then identified through multidisciplinary discussions.Of 2,191 safety incidents identified from 2,178 reports, 30% (n = 658) were harmful, including 12 deaths and 41 cases of severe harm. The children involved in these incidents had respiratory conditions (n = 387; 18%), injuries (n = 289; 13%), nonspecific signs and symptoms, e.g., fever (n = 281; 13%), and gastrointestinal or genitourinary conditions (n = 268; 12%), among others. Priority areas for improvement included safer systems for medication provision in community pharmacies; triage processes to enable effective and timely assessment, diagnosis, and referral of acutely sick children attending out-of-hours services; and enhanced communication for robust safety netting between professionals and parents. The main limitations of this study result from underreporting of safety incidents and variable data quality. Our findings therefore require further exploration in longitudinal studies utilizing case review methods.ConclusionsThis study highlights opportunities to reduce iatrogenic harm and avoidable child deaths. Globally, healthcare systems with primary-care-led models of delivery must now examine their existing practices to determine the prevalence and burden of these priority safety issues, and utilize improvement methods to achieve sustainable improvements in care quality.

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Section: Discussionmentioning

confidence: 99%

Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis

et al. 2017

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“…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%

“…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. 117 One study identified 33% of ED referrals as non-essential 139 and another identified that a high proportion of ED referrals should have been handled in primary care. 116 Most studies reported that a high proportion of referrals, often in excess of 90%, were appropriate.…”

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

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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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“…The pandemic telemedicine model differs from the traditional consumer-driven one in which health care providers and a growing number of telemedicine venders offer a service designed to appeal to, and be chosen by, those who are most comfortable using technology as an enhancement to their lives. 20–23 The speed and convenience are geared to patients who will self-select telemedicine. By contrast, the COVID-19 pandemic and social distancing requirements resulted in a model in which the driver is a set of external conditions.…”

Section: Discussionmentioning

confidence: 99%

Rapid Conversion to a Completely Virtual Multidisciplinary ALS Clinic in Response to the COVID-19 Pandemic: Implications for Future Care Delivery

Grogan,

Walsh,

Haulman

et al. 2023

Journal of Clinical Neuromuscular Disease

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Objectives:The goals of this study were to assess the feasibility of maintaining multidisciplinary remote care, patient preferences, and outcomes of this transition because of COVID-19.Methods:From March 18, 2020 to June 3, 2020, 127 patients with amyotrophic lateral sclerosis (ALS) who were scheduled to be seen in our ALS clinic were contacted and scheduled according their preference for a telemedicine visit, telephone visit, or postponement until the next available in-person visit. Age, time from disease onset, ALS Functional Rating Scale-Revised, patient choices, and outcomes were recorded.Results:Patient visit preferences were 69% telemedicine, 21% telephone, and 10% postpone for a later in-clinic visit. Patients with higher ALS Functional Rating Scale-Revised were more likely to choose the next in-person opening (P = 0.04). Age and time from disease onset were not related to visit type preference. There were 118 virtual encounters, of which 91 (77%) began as telemedicine and 27 (23%) as telephone visits. Most telemedicine visits were conducted successfully, but 10 were converted to a telephone visit. The clinic maintained 88.6% of patient volume compared with the prior year, during which most visits were in-person.Conclusions:Telemedicine care using synchronous videoconferencing is preferable and feasible for most patients on short notice, with telephone as back-up. Clinic volumes can be maintained. These findings support the conversion of a multidisciplinary ALS clinic to 1 with exclusively virtual visits when future events again disrupt in-person care.

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Evaluation of an After-Hours Call Center

Abstract: Our study identifies that a third of unnecessary pediatric visits to the ED occurred as a result of the nurse triage telephone system in question. We recommend review of the algorithms stated to reduce strain on local ED resources.

Cited by 15 publications

References 17 publications

Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis

Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis

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

Rapid Conversion to a Completely Virtual Multidisciplinary ALS Clinic in Response to the COVID-19 Pandemic: Implications for Future Care Delivery

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