Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Abraham); and Department of Pediatrics, Columbia University Irving Medical Center, New York City, New York (Drs Avis, Caddle, Lane, and Friedman).
Qual Manag Health Care. 2022;31(3):191-195. doi: 10.1097/QMH.0000000000000346. Epub 2022 Feb 7.
BACKGROUND/OBJECTIVE: Phone triage systems are increasingly used by primary care clinics to improve patient satisfaction and direct low-acuity patients to appropriate care settings. Despite the prevalence of telephone triage, the majority of pediatric training programs do not include this practice in their curricula. Our aim was to increase the volume of after-hours patient phone calls per week by 25% and to secondarily reduce "treat and release" emergency department (ED) visits by 5% over the course of a 9-month quality improvement (QI) study.
A resident-led QI project was conducted from 2017 to 2019 at a mixed faculty-resident pediatric primary care practice providing care for an urban, primarily immigrant, underserved population. Eight Plan-Do-Study-Act cycles were developed on the basis of identified key drivers and included efforts to increase the visibility of the call service to patient families. After-hours calls were tracked and compared with similar practices, and ED visits for the first week of each month were reviewed using the electronic medical record system.
After promoting the service via various modalities, the number of after-hours calls increased by 30%, from an average of 6.5 calls per week to 8.5. Treat and release ED visits decreased by 6%, from a baseline of 64.3 to 60.3 visits per week.
The increased patient awareness of and availability of a reliable after-hours call service in pediatric practices are promising tools for reducing unnecessary ED visits, leveraging resident direction and implementation to promote the service through varying modalities.
背景/目的：电话分诊系统越来越多地被基层医疗诊所使用，以提高患者满意度，并将低危患者引导至适当的护理环境。尽管电话分诊已经很普遍，但大多数儿科培训项目并未将其纳入课程。我们的目标是在 9 个月的质量改进（QI）研究期间，每周增加 25%的非工作时间患者电话量，并次要减少 5%的“治疗后释放”急诊（ED）就诊量。
2017 年至 2019 年，在一家由混合教员-住院医师组成的儿科基层医疗实践中进行了一项以住院医师为主导的 QI 项目，为一个城市、主要是移民、服务不足的人群提供医疗服务。根据确定的关键驱动因素制定了 8 个计划-执行-研究-行动循环，包括努力提高患者家庭对电话服务的可见度。跟踪非工作时间的电话，并与类似实践进行比较，使用电子病历系统审查每月第一周的 ED 就诊情况。
通过各种方式宣传服务后，非工作时间的电话量增加了 30%，从平均每周 6.5 次增加到 8.5 次。治疗后释放 ED 就诊量减少了 6%，从基线的 64.3 次减少到每周 60.3 次。
儿科实践中增加了患者对可靠的非工作时间电话服务的认识和可及性，这是减少不必要的 ED 就诊的有前途的工具，利用住院医师的指导和实施，通过各种方式来推广该服务。
