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PEDIATRICS Vol. 110 No. 5 November 2002, pp. 865-872

Caller Satisfaction With After-Hours Telephone Advice: Nurse Advice Service Versus On-Call Pediatricians

Thomas J. Lee, MHS, MD^*, Judith Guzy, BSN^*, David Johnson, PhD, Heide Woo, MD and Larry J. Baraff, MD^*,

^* Emergency Medicine Center, David Geffen School of Medicine at UCLA, Los Angeles, California
McKesson Access Health Services, Broomfield, Colorado
Mattel Children’s Hospital, Los Angeles, California

--> Objective. To compare caller satisfaction with after-hours medical advice provided by a for-profit nurse advice service with advice provided by on-call pediatricians.

Methods. The study setting was the general pediatrics faculty practice of an urban university medical center. Participants were parents or guardians of a population of 6000 children calling for after-hours medical advice over a 10-month period from January 18 to November 20, 2000. After-hours medical advice calls were randomized to either a nurse advice service or the on-call pediatrician. Caller satisfaction and subsequent health care utilization were measured by a telephone survey of callers and review of all health care visits within 3 days of the initial telephone advice call.

Results. Five hundred sixty-six (48%) callers were enrolled in the on-call pediatrician group, and 616 (52%) were enrolled in the advice nurse group. Caller satisfaction was rated as very good or excellent significantly more often for the on-call pediatrician than for the nurse advice service as follows: telephone call overall (68.5% vs 55.0%; 95% confidence interval [CI] of difference: 8.0%–19.0%), thoroughness and competence of the person they spoke with (74.0% vs 59.1%; 95% CI of difference: 9.6%–20.2%), courtesy and friendliness of the person they spoke with (77.4% vs 73.9%; 95% CI of difference: -1.4%-8.4%), length of time spent waiting (70.8% vs 60.1%; 95% CI of difference: 5.4%–16.2%), time spent talking with the on-call pediatrician or advice nurse (68.2% vs 52.4%; 95% CI of difference: 10.2%–21.3%), and the medical advice given (68.6% vs 53.9%; 95% CI of difference: 9.2%–20.1%). Compliance with the advice given was significantly higher for office care in the on-call pediatrician group (51.5% vs 29.6%; 95% CI of difference: 8.9%–34.2%). Repeat calls for advice were significantly more frequent for the nurse advice service, both within 4 hours (13.0% vs 4.8%; 95% CI of difference: 5.0%–11.4%), and within 72 hours (23.4% vs 13.3%; 95% CI of difference: 5.8%–14.5%).

Conclusion. Callers were less satisfied with medical advice provided by a nurse advice service compared with the traditional on-call pediatrician. The lower satisfaction was associated with somewhat poorer compliance with recommended triage dispositions and more frequent repeat calls for medical advice.

Key Words: telephone advice • primary care • pediatrics • family practice • management • triage • decision making • satisfaction • randomized controlled trial

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Received for publication Sep 11, 2001; Accepted May 16, 2002.

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