The Resident “Parent Pager” Introduction of a Telephone Triage Training Program Jennifer Bergquist, M.D., Alyna Chien, M.D., M.S., John Lantos, M.D. University of Chicago Hospitals Insert your information here Objective Methods Conclusion Background References Future Directions Literature on the importance of telephone medicine shows:  PCPs receive an estimated calls per week 1  ~1/3 of initial patient contacts are made via the telephone 2 Literature on telephone triage training shows:  Pediatricians already in practice lack confidence in telephone medicine 3  Pediatricians feel unprepared by their residency programs 3 Potential benefits of telephone triage availability and training:  Improved resident preparedness in telephone medicine 4  Higher patient satisfaction 3  Decreased inappropriate ED utilization 5 1. Roberts, KB, Starr, S, DeWitt, TG. The University of Massachusetts Medical Center Office – based Continuity Experience: Are We Preparing Pediatric Residents for Primary Care Practice? Pediatrics1997;100(4). 2. Wood PR. Pediatric resident training in telephone management: a survey of training programs in the United States. Pediatrics. 1986;77(6) Benjamin, JT. Pediatric Residents’ Telephone Triage Experience: Relevant to General Pediatric Practice? Arch Ped Adol Med. 1997;151(12) Roberts KB, Starr S, DeWitt TG. Resident Preparedness for Practice: A Longitudinal Cohort Study. Amb Ped. 2002;2: Piehl, MD, Clemens, CJ, et al. “Narrowing the Gap”: Decreasing Emergency Department Use by Children Enrolled in the Medicaid Program by Improving Access to Primary Care. Arch Ped Adol Med.2000;154: Mohr JJ, Randolph, GD, Laughon, MM, Schaff, E. Integrating Improvement Competencies Into Residency Education: A Pilot Project From a Pediatric Continuity Clinic. Amb Pediatrics. 2003;3: Combined qualitative and quantitative approach using:  Online survey of pediatric residents at the University of Chicago (n=49, 10 questions)  Face-to-face parent survey of patients who attend the “Peds B” resident clinic- Convenience Sample (n=45, 5 questions)  Face-to-face semi-structured interviews with FFHC attendings, clinic staff, residents and patients to construct a process map of healthcare access via telephone at FFHC  Analyzed encounter data for “Peds B” over a 7 month period to determine “capacity” in resident continuity clinics  Random sampling of patient charts in 5/2004 to determine “continuity rate” among individual residents Both residents and patients desire a structured telephone triage program for the “Peds B” clinic at FFHC Analysis shows telephone experience can be incorporated with minimal disruption, no cost, and would relieve call volume for staff members and patient overload for attendings at FFHC Other potential outcomes of a structured telephone triage program:  Improved access to care for patients  Increased physician confidence with telephone medicine  Decreased risk of liability with standardized documentation methods  Adherence to ACGME requirements through increased patient volume and urgent care experience Investigate the need for a structured telephone triage program for the resident continuity clinic at the Friend Family Health Center Results Monthly curriculum focusing on telephone triage skills and reviewing common phone calls within a general pediatric practice Development of a performance feedback system Survey post-intervention outcomes:  Family satisfaction with PMD accessibility  Effects on patient care outcomes  Overall preparedness of housestaff with phone triage skills post- residency  Effects on patient “continuity rate” within the resident clinics  Decrease in ED utilization? *Selected Questions from survey 1. Are you satisfied with our telephone triage system? 2. Would a structured telephone system be helpful? 3. Would having an attending back-up for advice be helpful? 4. Would you be interested in a monthly telephone medicine curriculum? * Selected Questions from survey 1. Do you know how to contact your PMD? 2. Would a 24hr “Parent Pager” be helpful if you had a medical question about your child? **There will be 1- 2 urgent care slots added to each resident’s schedule for patients requiring next day or same day visits FIGURE 3: Map of Healthcare Access Process at FFHC FIGURE 4: Average # patients seen per week by 1 st, 2 nd, 3 rd year residents over a 7mo period demonstrating:  capacity to add urgent care appts to resident schedules  Failure to meet ACMGE requirements for continuity clinic FIGURE 1FIGURE 2 FIGURE 5: Telephone triage process with use of a resident Parent Pager at FFHC