Hirsh Daniel A, Simon Harold K, Massey Robert, Thornton Lisa, Simon Joseph E
Department of Pediatrics, Emory University, Atlanta, Georgia, USA.
Pediatrics. 2007 Jun;119(6):1139-44. 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.
目标是（1）定义并阐述一种监测电话分诊安全性的自动化方法，（2）证明该方法合理地近似于一种更全面的安全指标，以及（3）描述所研究呼叫中心的这种自动化指标的逐月变化情况。
从2005年10月至2006年3月，一家三级儿科医院呼叫中心接到电话后患者的住院情况与其在呼叫中心的相应处置结果进行匹配。主医院24小时转诊不足率定义为呼叫中心接到治疗同一疾病或损伤的电话并将其判定为非紧急处置后，在24小时内入住研究机构的患者占总入院患者的百分比。对呼叫中心来电的一个便利样本进行调查，以了解转至其他机构的情况。然后将该样本与儿科医院的入院情况相结合，以估计真实的24小时转诊不足率。对转诊不足情况进行临床和统计分析。
主医院24小时转诊不足率为5.2%。估计的真实24小时转诊不足率为5.95%±2.75%。与转诊不足频繁相关的诊断包括肠胃炎、哮吼、哮喘和细支气管炎。入住研究机构的转诊不足患者平均住院1.6±1.1天，而呼叫中心转诊至更高护理级别的患者平均住院2.8±3.1天。主医院24小时转诊不足率的月度标准差为1.56%。
对于所研究的呼叫中心，主医院24小时转诊不足率能够轻松、客观地确定，并且合理地近似于真实的24小时转诊不足率。主医院24小时转诊不足率的逐月变化足够小，能够进行有意义的内部趋势分析。
