In response to an increase in the number of pediatric call centers in the United States, the Provisional Section on Pediatric Telephone Care and the Committee on Practice and Ambulatory Medicine of the American Academy of Pediatrics (AAP) have issued guidelines for the administration and management of these call centers. Major medical centers, physician practices and other health care organizations have established pediatric call centers that provide after-hours telephone care to patients of physicians or organizations who subscribe to the service. The guidelines, published as an insert in the November 1998 issue of AAP News, are intended to provide an outline for the operation of pediatric call centers and to form a framework for standards of care (see table).

The AAP defines pediatric call centers as medical units that provide health care management to patients whose primary care clinician practices within the broad scope of pediatrics. These include pediatricians, nurse practitioners, and general and family physicians. Services may include telephone triage and advice, physician referral, scheduling, utilization management, and disease and wellness management.

The AAP guidelines are divided into five sections: call center operations, patient access, nursing, physician interaction and total quality management.

Selected information from the five sections of the guidelines follows:

The personnel of a call center should include a medical director, a clinical (nurse) administrator and call center registered nurses. The call center nurses should provide the type of patient care that ensures the health, safety and comfort of all patients. Additional personnel who the AAP believes could help improve nurse productivity include a medical advisory committee, a nonclinical manager, clerical and technical support staff, and nurses with expanded roles such as a supervisor or a nurse who provides patient education.

All patients of a subscribing physician's practice or a contracting organization should have universal access to the call center regardless of insurance status, socioeconomic status or communication problems. They should be informed and educated about the triage and advice program. When patients call the center, they should immediately be told the status of the person with whom they are speaking.

The AAP emphasizes that specialty training and continuing education are essential to the success of telephone triage nursing care—an area that is heavily dependent on traditional nursing skills and extensive communication skills.

A physician representing a subscribing practice should be on-call at all times during which the call center is covering for that practice to help in the following situations listed in the guidelines:

• When callers insist on speaking with a physician.

• When health questions are beyond the comfort level of or the resources available to the nurse taking the call.

• When the physician elects to be contacted for certain acuity levels.

• When the nurse feels the caller will not comply with the advice.

All calls should be answered in a timely manner that reflects the nature of the call. Determining the urgency of a call should be based on the presenting problem as stated by the caller (see the table). The AAP report also contains tables listing policies and procedures related to risk management, policies and procedures to assist the triage process, documentation items, a suggested call-processing sequence and call priority definitions.

The AAP states that the guidelines will undergo modification and clarification as research into this growing field is performed and as clinical benchmarks are identified. Application of these and subsequent guidelines, according to the AAP, will mean that safe and quality patient care will always be the foremost goal of pediatric call centers, and this goal should not to be compromised by financial pressures.