The Host Hospital 24-Hour Underreferral Rate: An Automated Measure of Call-Center Safety

• Published in: Pediatrics (Evanston) 2007-06, Vol.119 (6), p.1139-1144
• Main Authors: Hirsh, Daniel A, Simon, Harold K, Massey, Robert, Thornton, Lisa, Simon, Joseph E
• Format: Article
• Language: English
• Subjects: After-Hours Care - methods; After-Hours Care - trends; Analysis; Automation; Biological and medical sciences; Call centers; Child; Child health; Children; Company business management; General aspects; Health aspects; Hospitalization; Hospitals, Pediatric - trends; Hotlines; Humans; Information Centers - trends; Management; Medical sciences; Patient safety; Pediatric clinics; Pediatrics; Referral and Consultation; Safety; Studies; Telephone; Triage - methods; Triage - trends
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2006-1986

The goals were to (1) define and illustrate an automated method of monitoring the safety of telephone triage, (2) demonstrate that this method approximates reasonably a more-global safety measure, and (3) describe the month-to-month variability of this automated measure for the call center studied. From October 2005 through March 2006, hospitalizations at a tertiary care pediatric hospital after calls to its call center were matched with their respective call-center dispositions. The host hospital 24-hour underreferral rate was defined as the percentage of total admissions to the study institution within 24 hours after a call to the call center for treatment of the same illness or injury that had been assigned a nonurgent disposition by the call center. A convenience sample of call-center calls was surveyed for admissions to other facilities. This sample was then combined with admissions to the pediatric hospital to estimate a true 24-hour underreferral rate. Underreferrals were subjected to clinical and statistical analyses. The host hospital 24-hour underreferral rate was 5.2%. The estimated true 24-hour underreferral rate was 5.95% +/- 2.75%. Diagnoses frequently associated with underreferral were gastroenteritis, croup, asthma, and bronchiolitis. Underreferred patients admitted to the study institution were hospitalized for an average of 1.6 +/- 1.1 days, compared with 2.8 +/- 3.1 days for patients referred by the call center to a higher level of care. The monthly SD of the host hospital 24-hour underreferral rate was 1.56%. For the call center studied, the host hospital 24-hour underreferral rate could be determined easily and objectively and approximated reasonably the true 24-hour underreferral rate. The month-to-month variability of the host hospital 24-hour underreferral rate was sufficiently small to allow for meaningful internal trending analyses.