Urban Wisconsin pediatric patients using an after-hours telephone triage service: outcomes and compliance.

OBJECTIVE: Evaluate the ability of a telephone triage service (TTS) to assess illness acuity of and patient compliance with advice given. DESIGN: Retrospective, observational study. PATIENTS: Patients of an urban, academic, pediatric clinic whose parents or caregivers called the TTS between July 23, 1997 and August 23, 1997. OUTCOME MEASURES: Patient outcomes and visit information at related medical encounters subsequent to a TTS call. RESULTS: Patients were primarily African-American, under age 5, enrolled in a Medicaid HMO, and most often called for fever, HMO authorization, or asthma. Homecare and PED referrals were the two most frequent dispositions; overall compliance rate was 60%. No patient referred for non-emergent care required care on an urgent or emergent basis. CONCLUSIONS: Initial results suggest that the TTS can effectively evaluate illness acuity in an urban population and compliance with advice is reasonable. A TTS may offer significant benefits to ensure care quality and contain costs in this population.

Code teams and the review of cardiac arrests.

A new system for responding to Codes, or resuscitations of patients with cardiopulmonary arrest, was implemented at St Luke's Medical Center, Milwaukee. A teaching program was begun to establish the Advanced Cardiac Life Support (ACLS) guidelines as the standard of care. A task force defined the composition of the Code team and was then designated the Code Review Committee, meeting monthly to review all Codes. Indicators for review were established. Code review is followed by a letter to the physician Code team leader and/or registered nurse. Data for 18 months, still preliminary, show improved compliance with indicators for documentation and for adherence to ACLS guidelines.