Triage Disposition Research Articles

Accuracy of telephone triage for predicting adverse outcomes in suspected COVID-19: an observational cohort study

ObjectiveTo assess accuracy of telephone triage in identifying need for emergency care among those with suspected COVID-19 infection and identify factors which affect triage accuracy.DesignObservational cohort study.SettingCommunity telephone triage provided...

Health system use and outcomes of urgently triaged callers to a nurse-managed telephone service for provincial health information after initiation of supplemental virtual physician assessment: a descriptive study.

British Columbia's 8-1-1 telephone service connects callers with nurses for health care advice. As of Nov. 16, 2020, callers advised by a registered nurse to obtain in-person medical care can be subsequently referred to virtual physicians. We sought to determine health system use and outcomes of 8-1-1 callers urgently triaged by a nurse and subsequently assessed by a virtual physician. We identified callers referred to a virtual physician between Nov. 16, 2020, and Apr. 30, 2021. After assessment, virtual physicians assigned callers to 1 of 5 triage dispositions (i.e., go to emergency department [ED] now, see primary care provider within 24 hours, schedule an appointment with a health care provider, try home treatment, other). We linked relevant administrative databases to ascertain subsequent health care use and outcomes. We identified 5937 encounters with virtual physicians involving 5886 8-1-1 callers. Virtual physicians advised 1546 callers (26.0%) to go to the ED immediately, of whom 971 (62.8%) had 1 or more ED visits within 24 hours. Virtual physicians advised 556 (9.4%) callers to seek primary care within 24 hours, of whom 132 (23.7%) had primary care billings within 24 hours. Virtual physicians advised 1773 (29.9%) callers to schedule an appointment with a health care provider, of whom 812 (45.8%) had primary care billings within 7 days. Virtual physicians advised 1834 (30.9%) callers to try a home treatment, of whom 892 (48.6%) had no health system encounters over the next 7 days. Eight (0.1%) callers died within 7 days of assessment with a virtual physician, 5 of whom were advised to go to the ED immediately. Fifty-four (2.9%) callers with a "try home treatment" disposition were admitted to hospital within 7 days of a virtual physician assessment, and no callers who were advised home treatment died. This Canadian study evaluated health service use and outcomes arising from the addition of virtual physicians to a provincial health information telephone service. Our findings suggest that supplementation of this service with an assessment from a virtual physician safely reduces the overall proportion of callers advised to seek urgent in-person visits.

Reducing Nonemergent Visits to the Emergency Department in a Veterans Affairs Multistate System

Study ObjectiveThe purpose of this quality improvement study was to reduce nonemergent visits to the emergency department attendance within a multistate Veterans Health Affairs network. MethodsTelephone triage protocols were developed and implemented for registered nurse staff to triage selected calls to a same-day telephonic or video virtual visit with a provider (physician or nurse practitioner). Calls, registered nurse triage dispositions, and provider visit dispositions were tracked for 3 months. ResultsThere were 1606 calls referred by registered nurses for provider visits. Of these, 192 were initially triaged as emergency department dispositions. Of these, 57.3% of calls that would have been referred to the emergency department were resolved via the virtual visit. Thirty-eight percent fewer calls were referred to the emergency department following licensed independent provider visit compared to the registered nurse triage. ConclusionTelephone triage services augmented by virtual provider visits may reduce emergency department disposition rates, resulting in fewer nonemergent patient presentations to the emergency department and reducing unnecessary emergency department overcrowding. Reducing nonemergent attendance to emergency departments can improve outcomes for patients with emergent dispositions.

Virtual Triage Practices in Emergency General Surgery Patients from Freestanding Emergency Departments: A 5-Year Analysis

INTRODUCTION: Freestanding Emergency Departments (FSEDs) have risen in popularity, reducing emergency department (ED) wait time and demand at overburdened hospitals. Although there has been limited evaluation into FSED utility in psychiatric populations, there are no data evaluating virtual triage disposition in surgical populations without physical examination by surgical team. We report our experience virtually triaging emergency general surgery (EGS) patients from an affiliated FSED to discharge, Level I trauma center (TC) or community hospital (CH). METHODS: EGS patients presenting to FSED with surgical consultation between 2016 and 2021 were analyzed. Outcomes included length of stay (LOS), surgical intervention, and 30-day mortality and readmission. Undertriage and overtriage rate was calculated and defined as: (1) discharge undertriage: discharge home with 30-day ED visit/readmission; (2) transfer undertriage: admission to CH requiring transfer to TC; and (3) overtriage: admissions <24 hours without operation. RESULTS: Of 1,105 patients, 167 (15%) were discharged home, 303 (27%) were transferred to TC, and 635 (58%) transferred to CH. Patients admitted to TC were older with higher Charlson Comorbidity Index scores and higher acuity pathology, but CH had higher operative rate and laparoscopy with shorter length of stay, operating room time, 30-day readmission, and mortality. Transfer undertriage was 0.9% (n = 6) with 1 due to disease acuity. Discharge undertriage was 12% (n = 20) due to worsening or stable pathology. Overtriage was 5.5% (n = 52) with most having a partial small-bowel obstruction or ambiguous diagnostic imaging necessitating observation. CONCLUSION: Virtual EGS triage at FSED to disposition, without an in-person examination, demonstrated both low undertriage and overtriage rate, reflecting appropriate triage practices.

A prospective, internal validation of an emergency patient triage tool for use in a low resource setting.

AimAssess the performance of a simple triage disposition score based on mental status, mobility and either oxygen saturation or respiratory rate by three principal metrics: 24 h mortality, the need for hospital admission and the urgency ranking of patient presentations.MethodProspective observational non-interventional study of consecutive patients presenting to the emergency and outpatient departments of a low-resource sub-Saharan hospitalResultsOut of 14,585 consecutive patients arriving to hospital 1,804 (12.4%) were admitted and 39 died (0.3%) within 24 hours. No patients with normal mental status or a stable independent gait died within 24 h, and 95% of those who did had an oxygen saturation <94%. The c statistic of the score for death within 24 hours was >0.95 and not significantly changed if respiratory rate replaced oxygen saturation as a score component, or mental status was assessed subjectively or objectively. However, an objective measure of mental status significantly reduced the c statistic for hospital admission from 0.970 SE 0.003 to 0.956 SE 0.004, p 0.002. The score attributed a higher acuity rating than the South African Triage System urgency ranking of presentations to 11.1% of patients and a lower acuity rating to 1.3%. However, 53% of the patients given a higher acuity rating were subsequently admitted to hospital and 6.1% of them died.ConclusionThe score identified patients who subsequently required hospital admission and who were likely to die within 24 hours.

Using Machine Learning Techniques to Predict Hospital Admission at the Emergency Department.

IntroductionOne of the most important tasks in the Emergency Department (ED) is to promptly identify the patients who will benefit from hospital admission. Machine Learning (ML) techniques show promise as diagnostic aids in healthcare.Aim of the studyOur objective was to find an algorithm using ML techniques to assist clinical decision-making in the emergency setting.Material and methodsWe assessed the following features seeking to investigate their performance in predicting hospital admission: serum levels of Urea, Creatinine, Lactate Dehydrogenase, Creatine Kinase, C-Reactive Protein, Complete Blood Count with differential, Activated Partial Thromboplastin Time, DDi-mer, International Normalized Ratio, age, gender, triage disposition to ED unit and ambulance utilization. A total of 3,204 ED visits were analyzed.ResultsThe proposed algorithms generated models which demonstrated acceptable performance in predicting hospital admission of ED patients. The range of F-measure and ROC Area values of all eight evaluated algorithms were [0.679-0.708] and [0.734-0.774], respectively. The main advantages of this tool include easy access, availability, yes/no result, and low cost. The clinical implications of our approach might facilitate a shift from traditional clinical decision-making to a more sophisticated model.ConclusionsDeveloping robust prognostic models with the utilization of common biomarkers is a project that might shape the future of emergency medicine. Our findings warrant confirmation with implementation in pragmatic ED trials.

Rapid design and implementation of an integrated patient self-triage and self-scheduling tool for COVID-19.

ObjectiveTo rapidly deploy a digital patient-facing self-triage and self-scheduling tool in a large academic health system to address the COVID-19 pandemic.Materials and MethodsWe created a patient portal-based COVID-19 self-triage and self-scheduling tool and made it available to all primary care patients at the University of California, San Francisco Health, a large academic health system. Asymptomatic patients were asked about exposure history and were then provided relevant information. Symptomatic patients were triaged into 1 of 4 categories—emergent, urgent, nonurgent, or self-care—and then connected with the appropriate level of care via direct scheduling or telephone hotline.ResultsThis self-triage and self-scheduling tool was designed and implemented in under 2 weeks. During the first 16 days of use, it was completed 1129 times by 950 unique patients. Of completed sessions, 315 (28%) were by asymptomatic patients, and 814 (72%) were by symptomatic patients. Symptomatic patient triage dispositions were as follows: 193 emergent (24%), 193 urgent (24%), 99 nonurgent (12%), 329 self-care (40%). Sensitivity for detecting emergency-level care was 87.5% (95% CI 61.7–98.5%).DiscussionThis self-triage and self-scheduling tool has been widely used by patients and is being rapidly expanded to other populations and health systems. The tool has recommended emergency-level care with high sensitivity, and decreased triage time for patients with less severe illness. The data suggests it also prevents unnecessary triage messages, phone calls, and in-person visits.ConclusionPatient self-triage tools integrated into electronic health record systems have the potential to greatly improve triage efficiency and prevent unnecessary visits during the COVID-19 pandemic.

Clinical and laboratory characteristics of patients presenting to a tertiary care center emergency department with invasive group A streptococcal infections.

The aim of this study was to describe the clinical and laboratory characteristics of invasive group A streptococcal infections in a geographic area that sees a high volume of cases. We conducted a health records review of consecutive patients presenting to the Thunder Bay Regional Health Sciences Centre Emergency Department (ED) in 2016-2017 with a diagnosis of invasive group A streptococcal infection using ICD-10 codes. Patient demographics, host characteristics, triage vital signs, laboratory values, culture sites, and disposition were described using univariate and bivariate statistics. Forty-four adult cases were identified over 2 years, with a median age of 44 years (interquartile range, 35-52). The most prevalent risk factors were diabetes mellitus (45%), current or previous alcohol abuse (39%), and current or previous intravenous drug use (34%). The two most abnormal triage vitals signs were a heart rate ≥ 100 beats per minute in 32 (73%) cases and a respiratory rate ≥ 20 breaths per minute in 27 (63%) cases. The temperature was ≥ 38°C in only 14 (32%) of cases. The C-reactive protein (CRP) was always elevated when measured, and greater than 150 mg/L in 20 (71%) of cases. One-third of patients had an ED visit in the preceding 7 days before the diagnosis of invasive group A Streptococcus. Invasive group A streptococcal infections often present insidiously in adult patients with mild tachycardia and tachypnea at triage. The CRP was the most consistently abnormal laboratory investigation.

Abstract TP417: An Autoregulation-Derived Prediction Model for Midline Shift After Ischemic Stroke

Introduction: Identification of patients likely to develop midline shift (MLS) after large-vessel occlusion (LVO) stroke is essential for appropriate triage and patient disposition. Studies have identified clinical and radiographic predictors of MLS, but with limited accuracy. Using an innovative assessment of cerebral autoregulation, we sought to develop an accurate predictive model for MLS. Methods: We prospectively enrolled 73 patients with LVO stroke. Beat-by-beat cerebral blood flow (transcranial Doppler) and arterial pressure (arterial catheter or finger photoplethysmography) were recorded within 24 hours of the stroke, and a 24-hour brain MRI was obtained to determine infarct volume and MLS. Autoregulatory function was quantified from pressure-flow relation via projection pursuit regression (PPR), allowing for characterization of 5 hemodynamic markers (Figure 1A). We assessed the predictive relation of autoregulatory capacity and radiological and clinical variables to MLS using recursive classification tree models. Results: PPR successfully quantified autoregulatory function in 50/73 (68.5%) patients within 24 hours of LVO ischemic stroke (age 63.9±13.6, 66% F, NIHSS 15.8±6.7). Of these 50 patients, most (78%) underwent endovascular therapy. Thirteen (26%) experienced 24-h MLS; in these patients, infarct volumes were larger (140.2 vs. 48.6 mL, P&lt;0.001 ), and ipsilateral (but not contralateral) falling slopes were steeper (1.1 vs. 0.7 cm·s -1 ·mmHg -1 , P=0.001 ). Among all clinical, demographic, and hemodynamic variables, only two (infarct volume, ipsilateral falling slope) significantly contributed to prediction of MLS (accuracy 94%; Figure 1B). Conclusions: This predictive model of MLS wields translatable potential for triaging level of care in patients suffering from LVO ischemic stroke, but further research, including optimization of the PPR algorithm as well as prospective use of the predictive model, is needed.

Interventions to reduce emergency department door-to- electrocardiogram times: A systematic review.

We sought to identify emergency department interventions that lead to improvement in door-to-electrocardiogram (ECG) times for adults presenting with symptoms suggestive of acute coronary syndrome. Two reviewers searched Medline, Embase, CINAHL, and Cochrane CENTRAL from inception to April 2018 for studies in adult emergency departments with an identifiable intervention to reduce median door-to-ECG times when compared with the institution's baseline. Quality was assessed using the Quality Improvement Minimum Quality Criteria Set critical appraisal tool. The primary outcome was the absolute median reduction in door-to-ECG times as calculated by the difference between the post-intervention time and pre-intervention time. Two reviewers identified 809 unique articles, yielding 11 before-after quality improvement studies that met eligibility criteria (N = 15,622 patients). The majority of studies (10/11) reported bundled interventions, and most (10/11) showed statistical improvement in door-to-ECG times. The most common interventions were having a dedicated ECG machine and technician in triage (5/11); improved triage education (4/11); improved triage disposition (2/11); and data feedback mechanisms (2/11). There are multiple interventions that show potential for reducing emergency department door-to-ECG times. Effective bundled interventions include having a dedicated ECG technician, triage education, and better triage disposition. These changes can help institutions attain best practice guidelines. Emergency departments must first understand their local context before adopting any single or group of interventions.

P021: Interventions to reduce emergency department door-to-ECG times: a systematic review

Introduction: We wished to identify emergency department interventions that lead to improvement in door-to-ECG times for adults presenting with symptoms suggestive of acute coronary syndrome (ACS). Methods: Two reviewers searched Medline, Embase, CINAHL and Cochrane CENTRAL from inception to April 2018 for studies in adult emergency departments with an identifiable intervention to reduce median door-to-ECG times when compared to the institution's baseline. Quality was assessed using the ‘Quality Improvement Minimum Quality Criteria Set’ (QI-MQCS) critical appraisal tool. The primary outcome was the absolute median reduction in door-to-ECG times as calculated by the difference between the post-intervention time and pre-intervention time. Results: Two reviewers identified 809 unique articles, yielding 11 before-after quality improvement studies that met eligibility criteria (N = 15,622 patients). The majority of studies (10/11) reported bundled interventions and most (10/11) showed statistical improvement in door-to-ECG times. The most common interventions were: having a dedicated ECG machine and technician in triage (5/11); improved triage education (4/11); improved triage disposition (2/11); and data feedback mechanisms (1/11). Conclusion: There are multiple interventions that show promise for reducing emergency department door-to-ECG times. Effective bundled interventions include having a dedicated ECG technician, triage education and better triage disposition. These changes, bundled together, can help intuitions attain best practice guidelines. Emergency departments must first understand their local context before adopting any single or group of interventions.

PP20 Using conversation analysis (ca) to explore 999-call recordings: what can micro-analysis of ‘talk’ reveal about help seeking for low-acuity conditions?

BackgroundAscertaining the appropriate clinical urgency of a 999 call is vital to ensure optimal resource utilisation. With numbers of calls to ambulances services for lower-acuity situations continuing the rise, it...

Process Improvement to Enhance Quality in a Large Volume Labor and Birth Unit.

The goal of the perinatal team at Mercy Hospital St. Louis is to provide a quality patient experience during labor and birth. After the move to a new labor and birth unit in 2013, the team recognized many of the routines and practices needed to be modified based on different demands. The Lean process was used to plan and implement required changes. This technique was chosen because it is based on feedback from clinicians, teamwork, strategizing, and immediate evaluation and implementation of common sense solutions. Through rapid improvement events, presence of leaders in the work environment, and daily huddles, team member engagement and communication were enhanced. The process allowed for team members to offer ideas, test these ideas, and evaluate results, all within a rapid time frame. For 9 months, frontline clinicians met monthly for a weeklong rapid improvement event to create better experiences for childbearing women and those who provide their care, using Lean concepts. At the end of each week, an implementation plan and metrics were developed to help ensure sustainment. The issues that were the focus of these process improvements included on-time initiation of scheduled cases such as induction of labor and cesarean birth, timely and efficient assessment and triage disposition, postanesthesia care and immediate newborn care completed within approximately 2 hours, transfer from the labor unit to the mother baby unit, and emergency transfers to the main operating room and intensive care unit. On-time case initiation for labor induction and cesarean birth improved, length of stay in obstetric triage decreased, postanesthesia recovery care was reorganized to be completed within the expected 2-hour standard time frame, and emergency transfers to the main hospital operating room and intensive care units were standardized and enhanced for efficiency and safety. Participants were pleased with the process improvements and quality outcomes. Working together as a team using the Lean process, frontline clinicians identified areas that needed improvement, developed and implemented successful strategies that addressed each gap, and enhanced the quality and safety of care for a large volume perinatal service.

Development of Clinical Ratings for Crisis Assessment In Community Mental Health

Few measurements have been developed to aid clinicians in mental health crisis assessment. Authors developed clinical dimensions from both experienced, licensed professionals working in crisis and salient characteristics of individuals presented to a crisis service located in a community mental health center. Five criteria, combined with a standard assessment protocol, were rated by 15 licensed professionals. These five criteria were tested as plausible dimensions for future measurement development. Clinical ratings by licensed professionals on 618 episodes of crisis over an 18-month period were analyzed to determine the latent structure and predictive potential of triage dispositions. The five criteria and a composite total were predictive of differential triage dispositions. An exploratory factor analysis indicated a two-factormodel, whichwe termed ‘‘self-destructive mood’’ and ‘‘perturbation.’’ Future development of thismodel and future refinement of this measure are discussed. [Brief Treatment and Crisis Intervention 8:304–312 (2009)]

How Safe Is Triage by an After-Hours Telephone Call Center?

Our goals were to assess (1) compliance with nurse disposition recommendations, (2) frequency of death or potential underreferral associated with hospitalization within 24 hours after a call, and (3) factors associated with potential underreferral, for children receiving care within an integrated health care delivery organization who were triaged by a pediatric after-hours call center. The study population included all pediatric patients enrolled in Kaiser Permanente Colorado whose families called the Children's Hospital after-hours call center in Denver, Colorado, during the period between October 1, 1999, and March 31, 2003. Postcall disposition recommendations were categorized as urgent (visit within 4 hours), next day (visit in > 4 hours but within 24 hours), later visit (visit in > 24 hours), or home care (care at home without a visit). Compliance with the nurses' triage disposition recommendations was calculated as the proportion of cases for which utilization data matched the disposition recommendations. Of the 32,968 eligible calls during the study period, 21% received urgent, 27% next day, 4% later visit, and 48% home care disposition recommendations. Rates of compliance with both urgent and home care disposition recommendations were 74%, and the rate of compliance with next day recommendations was 44%. No deaths occurred within < 1 week after the after-hours calls. The rate of potential underreferral with subsequent hospitalization was 0.2%, or 1 case per 599 triaged calls. In multivariate modeling, age of < 6 weeks or > 12 years and being triaged after 11 pm were associated with higher rates of potential under-referral. Approximately three fourths of families complied with recommendations for their child to be evaluated urgently or to be treated at home, with much lower rates of compliance with intermediate dispositions. The rate of potential underreferral with hospitalization was low, and age and time of call triage were associated with this outcome.

Relationship between race and ethnicity and forensic clinical triage dispositions.

Racial and ethnic disparities in the criminal justice system have been widely reported, as have racial and ethnic disparities in diagnoses and certain aspects of clinical management. This study examined the association between race and ethnicity and dispositions for pretrial defendants who were referred for forensic mental health evaluations. Available data were reviewed for all defendants in Massachusetts who were referred to a Massachusetts court clinic from 1994 to 2001 for a screening evaluation of their competence to stand trial, their criminal responsibility, or both. Logistic regression models were developed to assess the relationship between defendants' race and ethnicity and the likelihood that they would be referred for inpatient evaluation and the likelihood that they would be evaluated within a strict-security facility. Race or ethnicity of the pretrial defendants was identified by clinicians. Blacks, but not Hispanics, were significantly more likely than whites to be referred for an inpatient evaluation after an outpatient forensic screening evaluation. Among male defendants, both Hispanics and blacks were more likely than whites to be referred for an inpatient evaluation in a strict-security facility, regardless of diagnoses and the level of severity of the criminal charges. Racial and ethnic disparities in disposition decisions exist within the forensic mental health system. These disparities, however, likely reflect numerous clinician and nonclinician variables.

Consistency of Triage Decisions by Call Center Nurses

To 1) assess consistency in triage disposition among pediatric telephone triage nurses using computer-based algorithms and 2) determine agreement between nurse dispositions and protocol dispositions. Fifteen nurses from the After Hours Telephone Care Program in Denver were randomly selected to receive mock calls from standardized patients. Each nurse received the same 15 scenarios. Reliability in triage disposition was assessed using the kappa statistic. Audiotapes of cases were reviewed if an urgent referral was warranted by the protocol but not given 20% or more of the time. Mean agreement among nurses for individual cases was 83% (range, 64%-100%). Overall interrater reliability among nurses for triage disposition was 0.46 (95% confidence interval, 0.43-0.49). Mean agreement between nurses' dispositions and protocol dispositions was 81% (range, 33%-100%). Audio review revealed no differences in length of call or information elicited between cases receiving urgent and nonurgent dispositions. Reasons for incorrect dispositions were 1) information necessary to make the disposition directed by the protocol was given and ignored and 2) nurses did not elicit the necessary information prescribed by the protocol. Agreement regarding disposition decisions among call center nurses and between nurses and protocols was close to 80%. Disagreement with protocol dispositions occurred when nurses 1) did not follow protocols or 2) did not act on information provided by the parent. Our data suggest a need for additional attention to communication skills and to protocol adherence in training and ongoing quality improvement practices.

Delivery of pediatric after-hours care by call centers: a multicenter study of parental perceptions and compliance.

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. 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. 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). 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.

After-Hours Telephone Calls to Obstetrician-Gynecologists

In Brief Objective To characterize the pattern, content, and management of after-hours telephone interactions between obstetrician-gynecologists and patients. Methods In a prospective observational study, 12 resident and nine private physicians practicing obstetrics and gynecology completed data cards for after-hours telephone interactions with patients. Chief complaints were categorized as related to either women's health or primary care and on whether women were pregnant, postpartum, or not pregnant. Triage dispositions (evaluate now, office follow-up, or home care) were compared between groups. Women also were asked what they would have done if they had been unable to contact their physicians by telephone. Results One hundred ninety-two of 276 calls evaluated (69.6%) were from pregnant women, 20 (7.2%) were from postpartum women, and 64 (23.3%) were from nonpregnant women. Calls were related to primary care health issues in 24.1% (n = 45) of pregnant women, 40% (n = 8) of postpartum women, and 28.1% (n = 18) of nonpregnant women. There were no differences between residents and private physicians in the proportion of women triaged to immediate evaluation for pregnancy (35.1% [n = 40] versus 41.9% [n = 31], P = .74) or postpartum (11.1% [n = 1] versus 10% [n = 1], P = .96) problems. Among 139 women triaged to office follow-up, 41% (n = 57) would have come to the hospital for emergency evaluation if they had been unable to reach their physicians. Conclusion Resident and private obstetrician-gynecologists provide primary care and women's health care advice during after-hours telephone calls from patients. More than one third of after-hours telephone calls from pregnant women are triaged to immediate evaluation. Resident and private obstetrician-gynecologists provide primary care and women's health care advice in after-hours telephone calls from women.

After-hours telephone calls to obstetrician-gynecologists

Objective: To characterize the pattern, content, and management of after-hours telephone interactions between obstetrician-gynecologists and patients. Methods: In a prospective observational study, 12 resident and nine private physicians practicing obstetrics and gynecology completed data cards for after-hours telephone interactions with patients. Chief complaints were categorized as related to either women’s health or primary care and on whether women were pregnant, postpartum, or not pregnant. Triage dispositions (evaluate now, office follow-up, or home care) were compared between groups. Women also were asked what they would have done if they had been unable to contact their physicians by telephone. Results: One hundred ninety-two of 276 calls evaluated (69.6%) were from pregnant women, 20 (7.2%) were from postpartum women, and 64 (23.3%) were from nonpregnant women. Calls were related to primary care health issues in 24.1% ( n = 45) of pregnant women, 40% ( n = 8) of postpartum women, and 28.1% ( n = 18) of nonpregnant women. There were no differences between residents and private physicians in the proportion of women triaged to immediate evaluation for pregnancy (35.1% [ n = 40] versus 41.9% [ n = 31], P = .74) or postpartum (11.1% [ n = 1] versus 10% [ n = 1], P = .96) problems. Among 139 women triaged to office follow-up, 41% ( n = 57) would have come to the hospital for emergency evaluation if they had been unable to reach their physicians. Conclusion: Resident and private obstetrician-gynecologists provide primary care and women’s health care advice during after-hours telephone calls from patients. More than one third of after-hours telephone calls from pregnant women are triaged to immediate evaluation.