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Estimating Weekly Call Volume to a National Nurse Telephone Triage Line in an Influenza Pandemic.

ABSTRACT: Telephone nurse triage lines, such as the Centers for Disease Control and Prevention's (CDC) Flu on Call®, a national nurse triage line, may help reduce the surge in demand for health care during an influenza pandemic by triaging callers, providing advice about clinical care and information about the pandemic, and providing access to prescription antiviral medication. We developed a Call Volume Projection Tool to estimate national call volume to Flu on Call® during an influenza pandemic. The tool incorporates 2 influenza clinical attack rates (20% and 30%), 4 different levels of pandemic severity, and different initial "seed numbers" of cases (10 or 100), and it allows variation in which week the nurse triage line opens. The tool calculates call volume by using call-to-hospitalization ratios based on pandemic severity. We derived data on nurse triage line calls and call-to-hospitalization ratios from experience with the 2009 Minnesota FluLine nurse triage line. Assuming a 20% clinical attack rate and a case hospitalization rate of 0.8% to 1.5% (1968-like pandemic severity), we estimated the nationwide number of calls during the peak week of the pandemic to range from 1,551,882 to 3,523,902. Assuming a more severe 1957-like pandemic (case hospitalization rate?=?1.5% to 3.0%), the national number of calls during the peak week of the pandemic ranged from 2,909,778 to 7,047,804. These results will aid in planning and developing nurse triage lines at both the national and state levels for use during a future influenza pandemic.

SUBMITTER: Adhikari BB

PROVIDER: S-EPMC6707072 | biostudies-literature | 2018 Sep/Oct

REPOSITORIES: biostudies-literature

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Estimating Weekly Call Volume to a National Nurse Telephone Triage Line in an Influenza Pandemic.

Adhikari Bishwa B BB Koonin Lisa M LM Mugambi Melissa L ML Sliger Kellye D KD Washington Michael L ML Kahn Emily B EB Meltzer Martin I MI

Health security 20180901 5

Telephone nurse triage lines, such as the Centers for Disease Control and Prevention's (CDC) Flu on Call<sup>®</sup>, a national nurse triage line, may help reduce the surge in demand for health care during an influenza pandemic by triaging callers, providing advice about clinical care and information about the pandemic, and providing access to prescription antiviral medication. We developed a Call Volume Projection Tool to estimate national call volume to Flu on Call<sup>®</sup> during an influ ...[more]

PMID: 30339099

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Project description:ImportanceFamilies often struggle after discharge of a child from the hospital. Postdischarge challenges can lead to increased use of urgent health care services.ObjectiveTo determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success.Design, setting, and participantsThis Hospital-to-Home Outcomes (H2O) randomized clinical trial included 966 children and adolescents younger than 18 years (hereinafter referred to as children) admitted to general medicine services at a free-standing tertiary care children's hospital from May 11 through October 31, 2016. Data were analyzed as intention to treat and per protocol.InterventionsA postdischarge telephone call within 4 days of discharge compared with standard discharge.Main outcomes and measuresThe primary outcome was the 30-day reutilization rate for urgent health care services (ie, unplanned readmission, emergency department visit, or urgent care visit). Secondary outcomes included additional utilization measures, as well as parent coping, return to normalcy, and understanding of clinical warning signs measured at 14 days.ResultsA total of 966 children were enrolled and randomized (52.3% boys; median age [interquartile range], 2.4 years [0.5-7.8 years]). Of 483 children randomized to the intervention, the nurse telephone call was completed for 442 (91.5%). Children in the intervention and control arms had similar reutilization rates for 30-day urgent health care services (intervention group, 77 [15.9%]; control group, 63 [13.1%]; P = .21). Parents of children in the intervention group recalled more clinical warning signs at 14 days (mean, 1.8 [95% CI, 1.7-2.0] in the intervention group; 1.5 [95% CI, 1.4-1.6] in the control group; ratio of intervention to control, 1.2 [95% CI, 1.1-1.3]).Conclusions and relevanceAlthough postdischarge nurse contact did not decrease the reutilization rate of postdischarge urgent health care services, this method shows promise to bolster postdischarge education.Trial registrationClinicalTrials.gov Identifier: NCT02081846.

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Project description:IntroductionCanadian patients presenting to the emergency department (ED) typically undergo a triage process where they are assessed by a specially trained nurse and assigned a Canadian Triage and Acuity Scale (CTAS) score, indicating their level of acuity and urgency of assessment. We sought to assess the ability of patients to self-triage themselves through use of one of two of our proprietary self-triage tools, and how this would compare with the standard nurse-driven triage process.MethodsWe enrolled a convenience sample of ambulatory ED patients aged 17 years or older who presented with chief complaints of chest pain, abdominal pain, breathing problems, or musculoskeletal pain. Participants completed one, or both, of an algorithm generated self-triage (AGST) survey, or visual acuity scale (VAS) based self-triage tool which subsequently generated a CTAS score. Our primary outcome was to assess the accuracy of these tools to the CTAS score generated through the nurse-driven triage process.ResultsA total of 223 patients were included in our analysis. Of these, 32 (14.3%) presented with chest pain, 25 (11.2%) with shortness of breath, 75 (33.6%) with abdominal pain, and 91 (40.8%) with musculoskeletal pain. Of the total number of patients, 142 (47.2%) completed the AGST tool, 159 (52.8%) completed the VAS tool and 78 (25.9%) completed both tools. When compared to the nurse-driven triage standard, both the AGST and VAS tools had poor levels of agreement for each of the four presenting complaints.ConclusionsSelf-triage through use of an AGST or VAS tool is inaccurate compared to the established standard of nurse-driven triage. Although existing literature exists which suggests that self-triage tools developed for specific subsets of complaints may be feasible, our results would suggest that adopting the self-triage approach on a broader scale for all-comers to the ED does not appear to be a viable option to enhance the current triage process. Further study is required to show if self-triage can be used in the ED to optimize the triage process.

Dataset Information

Estimating Weekly Call Volume to a National Nurse Telephone Triage Line in an Influenza Pandemic.

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Estimating Weekly Call Volume to a National Nurse Telephone Triage Line in an Influenza Pandemic.

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