番茄社区

CHICAGO -- For parents of kids with endocrine disorders, a 24-hour paging service may be helpful for preventing trips to the emergency department (ED), researchers reported here.

Over the course of 1 year, the telephone service may have helped to prevent 190 potential ED visits, according to Colleen Nugent, MD, of BC Children's Hospital, and Shazhan Amed, MD, of the University of British Columbia, both in Vancouver.

"This telephone paging service has been provided by the endocrinology and diabetes unit at BC Children's Hospital for several decades, but has never been formally evaluated. We believed that evaluating this service was important to determine whether we are effectively meeting the needs of our patients and their caregivers," Nugent told 番茄社区 at The Endocrine Society's annual meeting.

She explained that she and her co-author hoped to determine how effective this service was at preventing ED visits, and to see who was utilizing the service, as well as their level of satisfaction with it.

"Additionally, not all children with diabetes are followed at our hospital, and are instead followed by community-based general pediatricians and pediatric endocrinologists. As such, they rarely use our telephone paging service. We hope to use these data to advocate for a provincial telephone paging service, that would provide urgent medical advice to all children living with diabetes in British Columbia," Nugent added.

During the study, there were 1,238 calls made to the paging service at the hospital's endocrinology and diabetes unit by patients and caregivers of patients. The paging service was staffed by a physician and available 24 hours a day. If appropriate, callers were invited to partake in a follow-up survey based upon the call.

Among the calls, 199 met the inclusion criteria -- calls from English-speaking parents or caregivers of young patients, or patients age ≥16 years, who were currently followed by a pediatric endocrinologist and needed urgent medical advice on diabetes or other endocrine-related disorders. Non-urgent administrative calls, such as prescription refills, and calls instructing patients to go immediately to an ED were excluded.

Of the calls meeting these inclusion criteria, 46 callers completed the 37-item follow-up questionnaire. The majority of these callers were for patients who had diabetes, while over 97% of these patients had type 1 diabetes. Nearly 40% of these patients were using an insulin pump. Among callers with other types of endocrine conditions, adrenal insufficiency was the most common.

The top reason why diabetes callers utilized the service was for a non-routine insulin dose adjustments (32%), followed by acute illness management (22%). Other top reasons why people phoned in were due to broken or lost diabetes supplies, persistent or severe hypoglycemia that required glucagon, and/or an insulin administration error.

Over 95% of callers were either satisfied or very satisfied with the service, including timeliness, communication style, and the medical advice provided. Nearly all of the patients did not require a visit to the ED within 72 hours of the phone call, while only two patients with type 1 diabetes were admitted to a hospital.

Most notably, 74% of these callers stated they would have gone to an ED had it not been for the telephone service.

"We were pleasantly encouraged by our findings that caregivers value this service, and feel strongly that it is preventing ED visits. Our results demonstrating that roughly 150 [ED] visits are prevented annually confirmed our hypothesis that the paging service is essential," Nugent stated.

However, these conclusions were based upon a small sample size with a generally higher socioeconomic status, so the researchers warned of a possible selection bias.

Nugent said the next stage of research is a cost-benefit analysis. "These data will allow us to confirm not only how many patients visited the ED at BC Children's Hospital after contacting our paging service, but also quantify the cost of such a visit," she said. "We hope that this analysis will show that we are providing a cost savings to the healthcare system which will enhance our ability to advocate for a provincial telephone paging service."

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