ABSTRACT 989

Abstract

Background and aims: Formal evaluation of our provincial critical care telephone consultation system has not been performed. Aims: To describe the process of providing advice, the content of the advice, and the planned disposition for patients for which calls were placed to the ICU at Toronto's Hospital for Sick Children. Methods: We retrospectively reviewed 100 consecutive consultations in January 2012 and December 2011. Descriptive analyses (SAS v9.3) were performed for patient demographic data, time of day and duration of consultations, interruptions, clinical information discussed, and advice provided to describe the individual impact of timing, primary system, and planned disposition on the duration of calls, interruptions, and information discussed. Results: Patients with a mean (SD) age of 3.1 (4.6) years were from 30 hospitals, a mean (SD) of 62.2 (102.8) km away. Half of calls were made during the day. The median (IQR) duration of consultations was 15 (11-21) minutes. The primary problem system was respiratory in 42. Interruptions occurred in 94% of calls. Recommendations were made in more than 75% of consultations and 55 patients had a planned disposition to the ICU. The number of interruptions, time to disposition decision, and the total duration of calls were not associated with planned disposition and the primary system involved. Duration of calls during the night were shorter (p<0.001) but the number of interruptions was unchanged. Conclusions: The content, flow and duration of calls, and disposition decision were not affected by the patient's problem system or ICU admission plan. This demonstrates a consistent service despite many consulting physicians.