During just 1 year, Colorado's statewide after-hours call-in system handled almost 142,000 night and weekend calls from parents and other caregivers seeking medical advice for children, Shira Belman, M.D., and colleagues reported.
Although 88% of the calls were for clinical illness, almost half of those were not medically urgent and resulted in advice on in-home care of the child. About 5% of the total calls were for information only, said Dr. Belman of the University of Colorado and her associates (Arch. Pediatr. Adolesc. Med. 2005;159:145-9).
Many of these calls might be averted “if more anticipatory information was provided in the physician's office or [if] parents were directed to other sources of information available after hours,” they wrote. “Investing in such alternatives should be especially appealing to physicians who answer their own after-hours calls or who pay out-of-pocket per call for a call center's services.”
The investigators analyzed all calls placed to the After Hours Telephone Care Program in Denver from June 1999 to July 2000. The center provides after-hours telephone triage to 90% of all Colorado pediatricians and is staffed by registered nurses who follow computerized triage algorithms. Calls result in advice to call 911, to seek urgent care, to contact the pediatrician within 24 hours, to contact the pediatrician within 72 hours, or to care for the child at home.
The 10 most common algorithms used were for vomiting (8.4% of all calls), colds (6%), cough (6%), earache (6%), fever (4%), sore throat (4%), diarrhea (3.4%), croup (3%), head trauma (2.6%), and eye infection (2.5%).
Only 21% of the callers were directed to seek urgent care, with only 1% of those told to call 911. Forty-five percent were advised how to care for the child at home; 30% were told to call their pediatrician the next day.
A small percentage of calls (5%) were for information only, including requests for the correct dose of over-the-counter medications, medication refill requests, questions about whether a condition was contagious, and calls to ask if certain medications could be administered simultaneously.
The highest volume of calls (29%) occurred in winter and the lowest (20%) in summer. Spring and fall had roughly equal volume (about 25% each).