Reducing after-hours referrals by an after-hours call center with second-level physician triage

Objectives. One-third of practices signing-out to The Children's Hospital C all Center in Denver, Colorado, choose to do second-level physician (SLP) t riage for calls judged by the Center to require after-hours referral (AHR). We examined: 1) the effect of SLP triage on the rate of AHRs and 2) reason s for physicians' decisions. Design. From January 1998 to August 1998 all calls from patients using a 5- member suburban pediatric practice judged by the Call Center to require AHR were referred to the practice's on-call physician who did SLP triage and c ompleted a questionnaire. Results. There were 955 eligible calls, 22% (N = 216) of which were initial ly given an urgent disposition by Call Center nurses. Physician questionnai res were completed for 97% (N = 209). Of patients initially triaged for AHR , 49% (N = 103) were subsequently given an AHR, 17% (N = 35) a next day off ice referral, and 34% (N = 71) home care and advice. Reasons for not urgent ly referring included the following: 1) medical problem didn't require urge nt evaluation (95%, N = 99); 2) change in the patient's condition; (40% N = 43); 3) prior knowledge of family's ability to evaluate and care for the p atient (40%, N = 43); and 4) knowledge of the patient's medical history (18 %, N = 19). After SLP triage the overall urgent referral rate was 11%. Conclusions. Signing out to a Call Center decreased physicians' after-hours calls by 77% and SLP triage halved the number of urgent after-hours referr als.