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AFTER HOURS OPTIONS: CONSIDERATIONS

Choosing an After-hours Call Center
After-hours call centers provide professional representation for the pediatric practice. Therefore, inquiry should be made about the professional level of the individuals answering calls, how they are trained and supervised, if they are certified, and which triage manuals and software are being used. You should also learn the name and degree of participation by the supervising physician. Inquiring about the volume of calls handled by the center, the number of physicians it serves, and its formal affiliations with insurers and hospitals may also be useful.

Both the service itself and its professional employees should be licensed in your state and should carry their own liability insurance.

The malpractice insurer for the pediatric practice and its participating healthcare plans should agree in writing that use of this outside provider for after-hours calls does not violate contractual agreements.

It is strongly recommended that a practice physician should review triage protocols at regular intervals to be certain that they conform to practice recommendations and advice. Discrepancies should be noted and discussed with an appropriate call center representative.

Choosing a Telephone Answering Service
In most cases, telephone answering service personnel have no formal medical training and minimal medical knowledge. Their primary function is to relay messages accurately and in a timely fashion. However, informal triage of calls occurs when the operator must decide whether a physician should be contacted on an urgent basis. It is therefore recommended that the service agree to follow written instructions provided by practice physicians. The list should be short, avoid medical and technical terminology, and allow for over-screening of calls. Except in special circumstances, it is best not to list all of the conditions for which you would like to be called, e.g. trouble breathing, high fever, head trauma, etc. The list is too long to be practical and exclusions might create liability. An example of such instructions is given below:

Unless you are otherwise notified, our physician will call in once every 90 minutes for non-urgent calls. However, the physician should be called or paged immediately if:

1. The caller believes the call is an emergency. (Best screening question: "Is this call an emergency?" or "Do you feel frightened about the way your child looks or is acting?")
2. The caller believes the problem can't wait until the next call-in time. (Best screening question: "The doctor will be calling in at 9 o'clock, but I can page her if you believe this problem can't wait.")
3. You (the service operator) believes the call is an emergency because of the type of complaint or because the caller seems very nervous.
4. The caller has made multiple calls about the same problem.
5. The patient is an infant less than 2 months of age who has fever or is acting sick.

Finding a Call Center

Critical Success Factors in Pediatric Call Centers

AAP News Article "Weigh Costs and Benefits When Selecting After-hours Triage Service"