Use of a telephone advise line in an accident and emergency department

Subjects, methods, and results

Telephone calls to our department requesting advice are tape recorded and dealt with by a trained nurse (of at least six months' experience) or a doctor as an additional duty. During the study (19 October to 4 December 1992) we recorded the caller's and patient's names; their relationship; the sex, age, and medical problem of the patient; and the address and telephone number of the caller. Patients were advised to attend our department or their general practitioner or were given some other advice. All callers were then telephoned or sent a questionnaire within 72 hours to find our what action they had taken and how satisfied they had been with the advice. If not fully satisfied they were asked to give their reasons. All advice was assessed by the department's consultants and registrar (CVE).

During the study 145 calls were made, 104 of which were followed up; 41 callers did not respond to a postal questionnaire. The 104 calls concerned 108 patients, half of whom were male; patients' ages ranged from 3 months to 86 years, and 39 were aged 5 years or less. Thirty four calls were made by the patient and 70 by someone else - chiefly mothers (39 calls), fathers (seven), partners (six), and friends (five). Seventy five callers were women and 29 men.

Forty six calls concerned paediatric patients (14 years or younger) and dealt with minor trauma (22 calls), medical problems (12), accidental ingestion of drugs or other substances (eight), and ingestion or insertion of foreign bodies (four). The 58 calls concerning adult patients were mostly about medical problems (25) and minor trauma (22), with overdose, problems with plaster casts, and dental problems each having three calls (table).

Fifteen callers were advised to attend their general practitioner and 12 complied; 67 were advised to attend this department and 65 complied; and 22 were given other advice, with which they all complied. Overall, 99 callers complied with the advice, which was given in 78 (75%) calls by a nurse and in 26 (25%) by a doctor. The advice was appropriate in 102 cases. Two callers were given inappropriate advice: one patient with a painful filling was told to attend this department rather than a dentist, and a mother was advised to bring her child who had ingested harmless amounts of antifungal cream to the department.

One hundred callers were fully satisfied with the advice. Two men were partially satisfied because they did not consider it necessary to attend the department as appropriately advised after having been bitten by a pet rat in one case and for dizziness after a head injury in the other. Two mothers whose young children had ingested harmless amounts of drugs were dissatisfied with the advice given; one was inappropriately advised to attend as described in the previous paragraph and the other was correctly advised to take no action.

Comment

There is a public demand for medical advice available over the telephone. The National Audit Office encourages advice lines as a means of encouraging appropriate attendances at accident and emergency departments.2 Swedish studies of such a service seem encouraging,3 but American research is less enthusiastic.4,5 Our service requires no additional staff and uses a half speed tape recorder costing pounds sterling 80.00 and one 90 minute tape a month to record about 70 calls. We conclude that our advice line is a low cost, safe service that provides public access to health information and encourages consultation with a doctor as appropriate.