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

Background. Despite the rapid growth of centralized call centers to provide after-hours triage to patients of multiple providers, little is known abou t the perceptions of parents regarding this type of care and their complian ce with triage disposition recommendations. Design/Methods. From August through September 1999, randomized samples of a fter-hours calls were selected each day from computerized records at 4 pedi atric 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, S t Petersburg, Florida. All participating call centers use the same triage s oftware. Calls were randomly selected to yield at least 250 callers with no nurgent dispositions and 100 with urgent dispositions from each site. Telep hone surveys to callers were conducted by an external survey unit 3 to 7 da ys after the call to the call center. Results. Surveys were completed for 70.5% of those sampled (N = 1561). Pare nts indicated they were very satisfied or satisfied with aspects of care re ceived 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 l evel of college graduate or higher (OR: 1.30) were significant predictors o f preferring to speak with a physician. Of the 37.0% (N = 723) of parents w ho 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 chan ge to be positive. Reported compliance with the call center disposition rec ommendation was 83.3% for urgent referral, 41.0% for next day, 4.5% for vis it at a later time, and 78.2% for home care. The major reason given by pare nts for noncompliance was reporting that they heard a different disposition (76.9% for urgent to 100% for visit at a later time). Conclusions. Parental satisfaction with pediatric call centers was uniforml y high in 4 different geographic locations, and almost all parents who repo rted any effect on their relationship with their primary provider assessed it as positive. Compliance with recommendations for urgent evaluation or ho me care was relatively high but for intermediary dispositions was low. In m ost cases in which noncompliance occurred, parents reported hearing a diffe rent disposition. Additional study is needed to clarify whether noncomplian ce, especially in cases in which an urgent recommendations was made, is att ributable to poor nurse communication of the recommended disposition, paren tal misinterpretation, or parental difference of opinion.