PEDIATRIC CALL CENTERS AND THE PRACTICE OF TELEPHONE TRIAGE AND ADVICE: CRITICAL SUCCESS FACTORS

strategies for PRACTICE manageMENT
A Report from the Provisional Section on Pediatric Telephone Care
and the Committee on Practice and Ambulatory Medicine
NOVEMBER 1998
PEDIATRIC CALL CENTERS
PEDIA
AND THE PRACTICE OF TELEPHONE TRIAGE AND ADVICE:
CRITICAL SUCCESS FACTORS
CRITICAL SUCCESS F
T
their reliance on demand management (eg,
in the current practice of medicine and that
here has been dramatic growth in the
providing the best medical care to the most
telephone care has been estimated to
development and implementation of pedi-
patients in the most appropriate cost-effec-
account for 12% to 27% of the practice of
atric call centers. Major medical centers,
tive setting) — all contributed to the growth.
pediatrics,(3,4) no quality assurance guide-
insurance companies, physician groups, and
In addition, health care mergers and down-
lines have been created for medical call
other health care organizations have estab-
sizing resulted in less contact between the
centers. The following monograph identi-
lished pediatric call centers and they are
physician and the patient. Integrated deliv-
fies and describes critical success factors
rapidly becoming the standard of pediatric
ery systems and managed care
designed to facilitate the safe and effective
after-hours telephone care in many commu-
organizations (MCOs) structured them-
operation of pediatric call centers and the
nities.(1,2) It is conservatively estimated that
selves to facilitate easy access to health care
practice of high-quality triage and advice.
currently 25% of all general pediatricians
services while preventing the excessive cost
Currently there are over 50 pediatric call
use an after-hours call center to address
associated with inappropriate emergency
centers across the country; hundreds more
their patients’ needs.(1,2) The primary stim-
room and urgent care center visits.
provide pediatric and adult services.
uli supporting their growth are managed
Physician report cards, the National
Numerous managed care and pharmaceuti-
care and the increased emphasis on demand
Committee on Quality Assurance’s (NCQA)
cal companies and even national drug store
management. However, the need to com-
Health Plan and Employer Data Information
chains have advice lines. It has been esti-
bine quality demand management services
Set (HEDIS)®3.0 performance measures, the
mated that approximately 35 million people
with efficient and productive telephone care
Joint Commission on the Accreditation of
have access to telephone triage and advice,
creates a potential marketplace conflict that
Healthcare Organization’s (JCAHO) require-
with the number growing exponentially.(5)
may lead to the practice of less than optimal,
ments, and the Clinical Laboratory
For example, a 1993 study reported the suc-
or even unsafe, telephone care.
Improvement Amendment Acts of 1988
cess of the Denver After-Hours Program in
The growth in telephone medicine was
(CLIA) mandates, and hospital quality-of-
which over 100,000 calls were answered with
the result of several factors that emerged in
care reports have all become means to
no reported major adverse outcome. The
the early 1990s. Changes in physician
ensure the delivery of optimal patient care
program obtained a 100% physician satisfac-
lifestyle, research demonstrating nurses’
while contributing to the reduction in medi-
tion and 96% to 99% patient satisfaction
competency to perform telephone triage,
cal care costs seen in recent decades.
rating.(1)
growth in managed care, and the emergence
Despite the facts that quality monitoring
In response to this growing trend, the
of vertically integrated systems of care and
and standards of care have become routine
American Academy of Pediatrics (AAP)
1 Poole SR, Schmitt BD, Carruth T, et al. After-hours telephone coverage: the application of an area-wide telephone triage and advice system for pediatric practices. Pediatrics.
1993;92:670-679
2 Pert JC, Furth TW, Katz HP. A 10-year experience in pediatric after-hours telecommunications. Current Opinion in Pediatrics. 1996; 8:181-187
3 Bergman AB, Dassel SW, Wedgewood RJ. Time-motion study of practicing pediatricians. Pediatrics. 1966; 38:254-263
4 Hessel SJ, Haggerty RJ. General pediatrics: a study of practice in the mid 1960’s. Pediatrics. 1968; 73:271-279
5 How nurses take calls and control the care of patients from afar. The Wall Street Journal. February 4, 1997

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formed the Provisional Section on Pediatric
management. Pediatric call centers do not
The call center nurse will provide patient
Telephone Care. The Provisional Section is
routinely provide Emergency Medical Ser-
care that ensures the health, safety, and com-
to organize the study and advancement of
vices (EMS). Pediatric call centers practicing
fort of patients. This is accomplished
telephone triage and advice as it relates to
telephone triage and advice use trained reg-
through health education in disease preven-
patient outcomes, standards of care, and res-
istered nurses to provide the systematic
tion and management and referral to
ident/physician education.
assessment of patient’s needs through the
appropriate medical care. The call center
use of standardized protocols, algorithms, or
DEVELOPMENT OF GUIDELINES
nurse performs symptom-based triage guid-
guidelines. Call centers may act as physi-
ed by clinical algorithms, guidelines and/or
In response to this national growth in
cian representatives or operate for the
protocols, and policies and procedures. Fol-
pediatric call centers, clinical and adminis-
benefit of the general public or specific
lowing these nursing resources, the call
trative representatives from pediatric call
health care organizations.
center nurse has to interpret, clarify, priori-
centers across the country (four physicians,
tize, differentiate, discern, and integrate
seven nurses, a hospital administrator, and
CALL CENTER OPERATIONS
an attorney) have collectively developed
clinical information to make a triage deci-
A. Personnel Structure
these guidelines for the administration and
sion as to whether the child needs to be seen
The call center’s personnel structure pro-
management of pediatric call centers. Tele-
immediately, urgently, or for a scheduled
vides a framework within which telephone
phone triage and advice standards for
appointment, or whether the child and/or
triage and advice is performed.
nursing practice have been established,(6)
patient needs advice about home care man-
The structure should include a medical
and recently standards for the accreditation
agement or other dispositions.
director, clinical (nurse) administrator, and
of call centers associated with managed care
Other Personnel
call center registered nurses.
organizations (MCOs) have been pro-
Call centers may utilize the following
Medical Director
posed.(7) As the number of call centers
personnel to improve nurse productivity
The pediatric call center organization
increases nationally, there is a need to estab-
and assure optimal quality: medical adviso-
structure should include a board-certi-
lish guidelines that will hold providers and
ry committee, non-clinical manager, clerical
fied/board-eligible pediatrician acting as
call centers accountable for providing timely
and technical support staff, and nurses with
the medical director. If a pediatrician is not
access to care in an appropriate setting with-
expanded roles such as supervisor or educa-
available to function as the medical director,
out compromising quality and, more
tion coordinator.
there should be one available to serve as a
importantly, patient safety. These guidelines
consultant. The medical director will be
are intended to provide a comprehensive
TABLE 1
responsible for and oversee the clinical
outline for the safe operation of pediatric
Policies and Procedures
operation of the call center. More specifical-
call centers and to form a framework for the
Related to Risk Management
ly, the medical director will write — or
development of standards of care.
review — and approve all triage and advice
• Communication with minors
These guidelines are divided into five
guidelines/protocols, prescription/nonpre-
• Noncompliant callers
sections: call center operations, patient
scription medication policies, and, any
• Angry callers
access, nursing, physician interaction, and
policies and procedures that ensure the safe
• Obscene callers
total quality management. The drafts were
• Inability to make contact with the
practice of telephone triage and advice, and
reviewed by staff of 12 pediatric call centers,
caller/patient (eg, wrong numbers, no
oversee the training of the nursing staff. The
members of the American Association of
answer, line busy and identified or
medical director also will act as a physician
unidentified answering machines)
Ambulatory Care Nursing and members of
liaison to physician and health care organi-
• Anonymous and noncontracted callers
the AAP Provisional Section on Pediatric
zation subscribers and will oversee the total
• Hearing and speech impaired callers
Telephone Care and the Committee on Med-
quality management programs.
and foreign language callers
ical Liability.
Clinical Nurse Administrator
• Back-up systems for technological
PEDIATRIC CALL CENTER
The clinical nurse administrator is
(power or equipment) failure, natural
disasters and, if computerized, process
DEFINITION
responsible for establishing and approving
for how and when to initiate manual
A pediatric call center provides health
nursing policies and job descriptions and
calls
care management to patients whose primary
managing the nursing staff needed to sup-
• Nurse medication prescribing patterns
care provider practices within the broad
port the call center. He or she also is
in accordance with state laws
scope of pediatrics. These providers include
responsible for the overall operation of the
• Access to Emergency Medical Services
pediatricians, nurse practitioners, and gener-
call center, including staff selection, training,
(EMS) and Emergency Medical Services
al and family physicians. Services provided
scheduling, and performance evaluations,
for Children (EMS-C)
by the call center may include, but are not
maintenance of all call processing, and the
• Confidentiality
limited to, telephone triage and advice,
implementation of the total quality manage-
• Documentation
• Nursing boundaries of practice
physician referral, scheduling, utilization
ment programs.
Out-of-state calls
management, and disease and wellness
Call Center Registered Nurse
6 Telephone Nursing Practice, Administration, and Practice Standards. American Academy of Ambulatory Care Nursing. Pitman, NJ: A.J. Janetti, Inc.,1997.
7 24 Hour Telephone Triage and Health Information Standards (Draft). American Accreditation Health Care Commission/URAC. Washington, DC: 1998.
2

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B. Policies and Procedures
for optional review by subscribing pri-
Symptom-based Triage
Nursing policies and procedures are nec-
mary care providers or health care
All symptom-based triage should be
essary to assist the practice and refine the
organizations.
documented utilizing a call form to be com-
judgment of the telephone triage nurse and
Printed References
pleted manually or a computerized
ensure the appropriate application of estab-
A Reference Library present within the
reporting system and should include the
lished guidelines/protocols. The
call center should contain pertinent texts
registration, clinical, and, when indicated,
management of calls that are not covered by
and books about pediatric health care.
medical information listed in Table 3.
clinical guidelines/protocols need to be
Physician Consultation
In situations in which no patient or caller
defined through policies and procedures.
Primary care providers (PCPs) contract-
contact is made, documentation should
Managing Risk
ing with the pediatric call center for
include whether a message was left on an
Nursing policies and procedures should
telephone triage and advice should make
identified or unidentified answering
outline the potential risk management
themselves, or a physician designee on-call,
machine, the time attempted call(s) was
issues that relate to the patient care popula-
available in a timely manner to the tele-
made with no answer, and/or the time an
tion served by the call center. Table 1
phone triage nurse and/or answering
attempted call(s) was made with a busy sig-
identifies key policies and procedures that
service for any questions regarding their
nal.
need to be in place.
patients. In addition, the medical director, or
If the call center staff initiates a follow-up
Assisting the Triage Process
his/her clinical designee, should be on-call
call, the documentation should include the
Policies and procedures that are identi-
and available in a timely manner to the tele-
patient’s current health status and any
fied in Table 2 should be used to assist with
phone triage nurse for consultation.
change in care advice or disposition.
the triage process.
Medical Laboratories
Archive of Records
C. Nursing Resources
If guidelines/protocols contain recom-
All telephone encounter documentation
When registered nurses accept the
mendations for ordering laboratory studies
should be archived.
responsibility of providing telephone triage,
(eg, throat cultures or tests to determine
they assume a specialized nursing role. To
bilirubin levels), the process should be stan-
PATIENT ACCESS TO CALL CENTER
assist them in performing this function in a
dardized. These guidelines/protocols
Universal access to the call center should
safe and efficient manner, nurses should
should contain clear indications for labora-
be available to all patients enrolled in a sub-
have access to the following medical and
tory referral, telephone numbers for
scribing physician’s practice or contracting
nursing resources: clinical triage guide-
laboratory sites, and instructions for dealing
organization. Patients should be informed
lines/protocols, printed references,
with test results.
physician consultations, medical laborato-
Pharmacies
TABLE 2
ries, pharmacies, and community resources.
If guidelines/protocols or related nurs-
Policies and Procedures
Clinical Triage Guidelines/Protocols
ing policies contain recommendations for
to Assist the Triage Process
Triage guidelines/protocols in printed
ordering new prescriptions and/or pre-
• Multiple symptom calls
and/or computerized format should be
scription refills, the process should be
• “No Protocol” calls (calls that do not fit
available to help the telephone nurse pro-
standardized.
into an existing protocol/guideline)
vide triage and advice. Triage
Community Resources
• Overrides of medical
guidelines/protocols should cover a large
A description of relevant services provid-
guidelines/recommendations
majority of incoming calls about ill or
ed, hours of operation, and the telephone
• Medications (new prescriptions, refill
injured children. All triage guidelines/pro-
numbers for emergency community ser-
prescriptions, and over-the-counter or
tocols should contain standard referral
vices should be available. Telephone
OTC medications)
criteria (dispositions) and standard treat-
numbers should be included for the call
• Laboratory tests
ment advice for managing symptoms at
center’s geographic area of coverage. These
• Suspected child abuse calls (eg,
home. Triage guidelines/protocols should
resources should include but are not limited
physical abuse, sexual abuse, neglect,
etc.)
be used on all calls for which they are avail-
to the following:
• Ingestions/poisonings calls
able. Finally, the triage guidelines/protocols
• Emergency medical transport
• Sexual assault calls
should undergo the following review pro-
• Child protective services
• Suicide calls/psychiatric-behavior
cess:
• Infectious disease contacts and expo-
management emergencies
1. Triage guidelines/protocols are initially
sure (Public Health Department)
• Chronic illness calls
written or reviewed, modified as neces-
• Police department
• 911/emergency calls
sary for local or regional standard of care,
• Poison center
• Procedure for telephone triage/advice,
and authorized by the call center’s medi-
• Sexual assault and rape crisis
referral, and follow-up for patients with
cal director and/or advisory committee.
resource(s)
non-contracting primary care
2. Triage guidelines/protocols are
D. Documentation
providers (PCPs) or no PCP
reviewed, updated as necessary, expand-
Documentation is the concise, factual
• Procedure for making referrals (eg,
after-hours site notifications, physician
ed and reauthorized at least yearly by the
record of a patient call. Documentation
referral)
medical director and/or medical adviso-
assists with continuity of care, quality
• Prioritizing incoming calls
ry committee.
assessment, and improvement, and it serves
3. Triage guidelines/protocols are available
as the medical record of the telephone call.
3

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of the relationship between the organiza-
regarding the triage and advice program.
extensive pediatric education and training
tion/practice and the call center to ensure
C. Access to Telephone Triage
and work under the supervision of a pedi-
continuity of care and patient and physician
Nursing Staff
atric-trained nurse. When available,
satisfaction.
Patients should have access to the pedi-
telephone triage nurses should strive for cer-
A. Overall Access
atric call center’s staff during contracted
tification.
All patients enrolled in a practice or
service hours through a telephone connec-
The telephone triage nurse should
organization that offers a telephone triage
tion via the practice’s or organization’s
demonstrate competency in Communica-
and advice service should have access to
telephone line, through an answering ser-
tion and technical skills and should be able
that service regardless of insurance, socioe-
vice, or by a direct telephone line to the call
to function automonously using the nursing
conomic status, disabilities, age or
center. All callers should be informed
process, critical thinking, assessment and
problem-solving skills, and good clinical
communication problems, providing the
immediately of the status (name and role) of
judgment.
patient/family has access to a telephone.
the staff member with whom they are
B. Training
B. Patient Notification
speaking (eg, first name, job title, etc).
Specialty training and continuing educa-
Pediatric call centers, acting in their role
NURSING
tion is essential to the success of telephone
as patient advocates, should advise all sub-
A. Education, Licensure, and Clinical Com-
triage nursing, an area in which nurses do
scribing practices and organizations to
petency
not rely on their vision or sense of touch, but
inform and educate their enrolled patients
The telephone triage nurse should be a
are heavily dependent on a blend of tradi-
graduate of an approved nursing program
tional nursing and extensive assessment and
TABLE 3
and should hold RN licensure according to
communication skills. The orientation and
Documentation Items
state laws. The telephone triage nurse
training program should include the teach-
should have experience in pediatric nursing
ing and evaluation of nurses on technical
I. Registration Information
or telephone nursing experience with pedi-
and communication skills, call center opera-
• Date and time of telephone call
atric patients. Nurses with experience that
• Name of nurse
tions (including details of available nursing
• Name of patient (unless call is
is not pediatric-based should undergo
resources and nursing policies and proce-
anonymous)
dures), the nursing process as it relates to
• Name of caller (unless call is
TABLE 4
telephone triage and advice (see Table 4), call
anonymous)
Suggested call-processing sequence
processing, and the skills needed to func-
• Name of PCP
tion autonomously. Specific instruction
• Patient’s date of birth (and
Assessment
should be given on the importance of prop-
calculated age)
• Receive, pre-triage, and prioritize
er documentation and other pertinent
calls
II. Clinical Information
patient care and risk management issues. It
• Conduct assessment interview:
• Presenting problem/symptom
history of present problem, relevant
is essential to the safe practice of pediatric
• Nursing assessment
past medical history, recent prior
telephone triage and advice that child devel-
• Relevant medical history and
calls if available
opment, wellness and disease be taught and
current medications.
Identification
that knowledge in these areas be assessed in
• Relevant allergies.
• Identify primary
the training program.
• Guideline/protocol or reference
problem/symptom
C. Nursing Clinical Competency
used.
• Identify emergency/high-risk
A periodic assessment of telephone triage
• Advice given (health education
situations
given).
nurse clinical competency should be per-
Triage
• Disposition recommended.
formed. The components of clinical
• Select appropriate
• Evaluation of patient’s/caller’s
competency should include, but not be lim-
protocol/guideline or nursing
understanding of care instructions
ited to, clinical judgment, appropriate
resource
and recommended disposition.
• Continue assessment interview
application of the nursing process, and
• Evaluation of patient’s/caller’s
• Determine recommended
knowledge of boundaries of practice and
intended action including follow-
disposition
accurate documentation.
up.
Intervention
D. Continuing Education
• Physician contact.
• Provide clinical care advice and
The telephone triage nurse should
III. Medication Information
education
demonstrate self-directed and/or continu-
• Prescription and OTC medication
Evaluation
ing education specific to the area of
instructions: dosage, route of
• Evaluate caller’s understanding of
pediatric and telephone nursing.
administration, frequency, and
advice
E. Boundaries of Practice
duration when indicated
• Evaluate caller’s potential for
The telephone triage nurse should
• Patient age
compliance
Conclusion
engage in a symptom-based practice, using
• Stated patient weight
• Consult PCP, refer, or arrange
the nursing process and resources approved
• Medication allergies
•
follow-up as indicated
by the medical director. Each nurse also
Other medication taken by the
patient
should function within the boundaries of
their license and their state’s Nurse Practice
4

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Act.
upon speaking with the physician direct-
total quality management program that
It is important to stress that employee
ly.
includes quality assessment, quality assur-
records should include documentation of
• In cases when the health questions go
ance, and quality improvement initiatives.
nursing education, licensure, pediatric expe-
beyond the ability, the comfort level, or
These programs should monitor the quality
rience, and training and performance
the resources available to the nurse tak-
and identify deficits related to the clinical
evaluation.
ing the call. These may include cases
and financial aspects of the call center.
outside the range of clinical
Established programs should be designed to
PHYSICIAN INTERACTION
guidelines/protocols or children with
monitor at least the specific following items.
Pediatric call centers act on behalf of and
chronic diseases or other special needs.
A. Call Response Time
in contractual agreement with physicians,
• The physician may elect to be contacted
It is essential to the practice of safe tele-
their practices, and/or health care organiza-
for certain acuity levels (eg, see immedi-
phone triage and advice that all patient calls
tions. Physicians or health care
ately, etc).
be answered in a timely manner, appropriate
organizations using call center services are
• In situations when a nurse believes a
to the severity of the reason for calling.
ultimately responsible for the triage and
caller will not comply with the recom-
Clearly, the level of severity can not be
advice given to their patients.(8) In order to
mended disposition.
assessed fully until a nursing assessment
ensure appropriate care for their patients,
C. Disposition Notification to Physician
has been performed. Therefore, determina-
physicians and health care organizations
Practices
tion of the urgency of the call should be
have obligations to the pediatric call center.
Call centers should notify subscribing
based on the presenting problem as stated
These obligations ensure the delivery of safe
physicians of the clinical disposition of all
by the patient/caller and the guidelines sug-
telephone triage and advice and enhance
calls by the next business day, if not sooner.
gested in Table 5.
continuity of care for the patient.
Potentially Emergent
A. Contracts
TOTAL QUALITY MANAGEMENT
Patients with symptoms that indicate an
Each physician or health care organiza-
All call centers should have in place a
tion using the services of the call center
should have a contract outlining the services
TABLE 5
provided and their obligations to the center.
Call Priority Definitions
Contracts may include statements regarding
physician’s or health care organization’s
Emergent calls include, but are not limited to, calls about the following:
agreement to use the triage and advice pro-
• Difficulty breathing (e.g., choking, stopped breathing, weak breathing, stridor, cyanosis,
tocols and pertinent additions prior to their
or other signs of respiratory distress)
use by the call center. In order to ensure
• Possible anaphylaxis (difficulty breathing or swallowing following medicine, bee sting,
prompt attention to the patient’s need for
food, or other possible allergen)
physician assessments and second-level
• Neurological symptom (eg, seizure, loss of consciousness, hard to awaken, confusion,
altered mental status, stiff neck)
triage, contracts also should delineate a rea-
• Poisoning, ingestion, drug overdose
sonable time period in which physicians
• Foreign body — in the airway (choking) or swallowed
should return pages from the call center.
• Trauma of the neck or eye
The mechanism for communication
• Electric shock
between the call center and the subscribing
• Near drowning
physician or health care organization, in
• Suicide — threats or attempts
regard to both verbal communication and
Urgent calls include, but are not limited to, calls about the following:
the telephone encounter document, should
• Trauma other than neck or eye
be stated clearly in the contract.
• Asthma, wheezing, or croup with no mention of difficulty breathing
B. Communication
• Foreign body — ear, nose, or vagina
To ensure that clinical issues are
• Bleeding (active) including blood in vomit or stool
addressed in a timely fashion and to guar-
• Burns except sunburn
antee patient continuity of care, it is
• Bites (eg, animal, snake, spider, marine animal, bee, yellow jacket — not insects or ticks)
essential that the physician and call center
• Fever over 105°F
communicate effectively and efficiently.
• Infant less than 3 months of age with fever
A physician representing a subscribing
• Severe pain, especially abdomen, head, or chest
• Possible dehydration
practice should be on-call and available at
• Purple or blood-colored rash
all times that the call center is covering for
• Heat exhaustion or stroke
that practice in order to assist in clinical situ-
• Hypothermia
ations that include but are not limited to the
• Psychosocial emergencies (sexual assault, child abuse, domestic violence)
following:
• In situations when callers are insistent
8 Policy on phone counseling. American Medical Association Report of the Board of Trustees (A-96). Chicago: 1997
5

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immediate life-threatening illness or injury
The use of pediatric call centers perform-
• Allison Kempe, MD, MPH
should be instructed at the point of first
ing nurse telephone triage and advice is
• Sanford Metzer, MD
contact with the call center to contact their
growing rapidly and has become the stan-
• Hanna Sherman, MD (Author)
local emergency medical services (EMS) or
dard of care in many regions of the country.
Committee on Practice
their emergency medical services for chil-
These operational and clinical practice
and Ambulatory Medicine
dren (EMS-C) or, if EMS is not available,
guidelines have been developed to ensure
• Jack T. Swanson, MD, Chairperson
have immediate access to the call center’s
the safe and effective operation of pediatric
• Edward O. Cox, MD
triage services.
call centers and the practice of optimal tele-
• F. Lane France, MD (SVM)
Potentially Urgent
phone triage and advice. These guidelines
• Katherine C. Teets Grimm, MD
Patients with symptoms that indicate ill-
pertain to the operation of a pediatric call
• James W. Herbert, MD
ness or injuries that could deteriorate into
center representing subscribing physicians
• E. Susan Hodgson, MD
life-threatening situations should have pri-
and health care organizations. They are
• Allan S. Lieberthal, MD
ority access to the call center.
intended to be used by call centers at all lev-
• Kyle Yasuda, MD
Non-urgent
els of development, from the initial planning
Liaisons
Patients with symptoms that indicate a
stage to the experienced fully operational
• Todd Davis, MD, Ambulatory Pediatric
delay in care would not result in life-threat-
call center.
Association
ening situation should have access to the call
These guidelines are based on current
• Robert D. Chessin, MD, Section on
center within a reasonable amount of time.
knowledge and data pertaining to the opera-
Administration & Practice Manage-
B. Caller Access
tion of pediatric call centers and the delivery
ment
Call centers utilizing the inbound call
of telephone triage and advice. They will
• Robert Sayers, MD, Uniformed Services
method (automated call distribution lines
undergo modification and clarification as
Section
with a patient initiated call) should keep
clinical benchmarks are identified and eval-
• Emmanuel E. Eugenio, MD, Resident
records of abandonment and blockage rates.
uated and as research into this burgeoning
Section
C. Patient/Physician/Medical Care
field is performed. Specific benchmark fig-
Organization Satisfaction
ures have been purposely omitted from this
Contributing Authors
Patient/caller and physician/medical
monograph since to date no formal evalua-
• Sherri Cotilla, RN
care organization satisfaction should be
tions identifying benchmarks with
• Mary DeBarr, RN
evaluated periodically, using a statistically
outcomes or quality significance have been
• Carol A. DiVella, RN
significant sample of callers.
performed. Comments, suggestions, and
• Jacquelyn Kopet-Feller, PNP
D. Clinical Guidance and Resource Use
collaborative data related to the topics listed
• Maureen Leahy, MBA, MPH
Appropriateness
in the total quality management section are
• Patricia Best Reisinger, MS, RN
Call encounter documents should be
strongly encouraged to guarantee the future
• Barton D. Schmitt, MD, FAAP
reviewed for appropriate triage guideline or
integrity and relevance of these guidelines.
• Carol M. Stock, MN, RN, JD
nursing resource selection.
These guidelines can not be applied in
• Sissy Tubb, RN, CPN
E. Disposition Appropriateness
entirety to the practice of office-based tele-
• Kathi Webster, RN
Call encounter documents should be
phone triage and advice since the level of
reviewed for appropriate caller disposition
physician involvement and triage goals may
and overall disposition rates should be eval-
be significantly different in an office setting.
uated routinely.
However, it is encouraged that these guide-
F. Clinical Outcomes
lines be used as a cornerstone for the future
Call centers are encouraged to investigate
establishment of office-based telephone care
routinely the clinical outcomes of care pro-
guidelines. Through the application of these
vided to patients. Outcomes analysis should
and subsequent guidelines, safe and quality
demonstrate reasonable health and func-
patient care will always be the foremost goal
tional status of patients. No adverse events
and will not be compromised by managed
resulting from a delay in diagnosis or treat-
care and financial pressures.
ment should occur. Call centers also should
Provisional Section on Pediatric
be encouraged to monitor “see-immediate-
Telephone Care Steering Committee
ly” referral rates and evaluate for
• Steven R. Poole, MD, Chairperson
unnecessary health care utilization patterns.
• Ben Gitterman, MD (Author)
CONCLUSION
• Andrew Hertz, MD (Author)
6

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