Emergency room telephone triage After hours telephone triage

-1 (0.773) 1 (0.474)

1 (0.760)

Notes: Maximum correlation is shown in parentheses. Correlation values are re-scaled from those reported in the paper to a more conventional range of 0 to 1.0. Adapted from Espino, J. U., Hogan, W., Wagner, M. M. (2003). Telephone triage: a timely data source for surveillance of influenza-like diseases. In: Proceedings of American Medical Informatics Association Symposium, 215-9, with permission.

Weekly regional number of influenza-like illness (ILI) cases from the United States.1 Influenza Sentinel Physicians Surveillance Network (CDC-RI).

Weekly regional number of positive influenza tests (CDC-RC).

They found a strong correlation between calls to emergency room telephone triage for respiratory problems and influenza (Table 28.3). The time latency was variable and no strong conclusion about earliness can be drawn from this study.

Henry et al. (2004b) used linked analysis (Chapter 21) to study the accuracy with which nurse advice hotline data predict the physician diagnosis (mapped by the researchers to a coarser "syndrome'' level of diagnostic precision) made during a subsequent office visit (Henry et al., 2004b).They also studied the time elapsed between each nurse advice call and the linked subsequent office visit.

They studied nurse advice hotline data from Kaiser Permanente of the Mid-Atlantic States for the period January— December 2002. In this clinical call center, nurses select from 586 nurse advice clinical practice protocols (e.g., diarrhea, adult). The researchers reviewed these protocols and assigned 68 to ESSENCE II syndromes based on their names and presumed usage (Figure 28.1).2

They studied the set of callers for whom a nurse had selected one or more of these 68 protocols and for whom they could also establish a link between the call and a subsequent office visit. They required that the link have the following characteristics: (1) the patient identification numbers for the hotline call and the office visit were identical, (2) the date of the hotline call was the same as the date the patient called for an appointment,

BOX. Classification lor coding of nurse advice guidelines — Kaiser Permanent» of the Mid-Atlantic States (KPMAS)

t.l ( gist tui West ¡nal) pain. asiuli Abdominal pain, pedijrric Acute ' ,1, gastroenteritis» adult Diarrltea. 0 2-1 iiinruhs, pediatric H LiirliL'.t. >2 veafs, pediatric Dbuhea, adult Diarrhw.toJig-term ca tv Diarrltea. pediatric Diarrhea. prenawl, CiBCYN I ll\' dârrhea,adult Nausen, adult Nausea, pediatric Vomiting and I", |- reinesis, J.I II I' Vomiting. lott^term care Vomiting, pedbt ric

DERMHtM (hemorrhagic manifestations) Rruiie/hetiwionia, id tilt

NE (.IRQ (neu 1 I [endache, idnll I leailache, long-rc tin care ] Icsdache. pediatric I IIY headache', id till I IIV mem jI statut changes. adult Meningitis. Hill ill

Mitling lis. neonates Meningitis, pedí al il, .11 ii> 11 il h s 2 years MetiingUii. ¡ied iatri c. child ren/young adults

Meningitis.pediatric, infants \1t II : IIj;i : is. pediatric, >2 Ve il-.

flïVKR Ferer. adult el. long-term care Fever, lk.N>i; I'eser pediatrk I 11V fever, adult

R[iM* (respiratory inliciion) Asthma. adult As ill m a pediatric RronchioiÎLÛ, pediatric Bronchitis, acme-» adult Ctimp. pediatric Earache, |v-*,i.i: nI IIV dyspnea, adult 1ÊIX" pneumonia, adult Influenza, itsluli n i l- 'i!.. pediatric Laryngitis, adult llespiratory distress. .tduh Shortness ofbteath, lone-term care

Sott throat. adult Sore throat, pediatric Throat culture, positive Upper restira lory infection, adult Upper respiratory infection, lung-icrm care

Upper respira lor)' inlect if ui, pediatric

1)1 i(MINI (dermatologie, infectious)

Chick« peats adult

Chicken pox, pediatric

fill h di sea se, pes! ial ric

1 Luid, tool, mouth disease, pediatric

I lerpes Foster, i-ti l

Herpes loiter/shingles, adult

Measles, pediatric

Rash. adult

Rash'fungal infection* adult Rashes. pediatric Rash, prenatal, OBCYN Roseola, pediatric Sit infles Smallpox

FIGURE 28.1 Six syndrome definitions based on 68 nurse advice protocols. (From Henry, with permission.)

1 The CDC defines influenza like illness as fever (temperature of >100°F) plus either a cough or a sore throat.

2 Magruder and collegues developed and evaluated an empirical method for creating syndrome groupings that they applied to call center data (Magruder et al., 2004).

table 2 8.4 Number of Nurse Advice Hotline Calls and Outpatient Office Visits, by Syndrome Group-Kaiser Permanente of Mid-Atlantic States, 2002

Syndrome Group

Number of Hotline Calls"

Number of Outpatient Office Visits"




Respiratory infection





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