# Implementation of After-Hours Nurse Line in an Academic Pediatric Endocrinology Practice

## TL;DR

An after-hours nurse line in a pediatric endocrinology practice improved care consistency and reduced physician workload, with no adverse outcomes for patients.

## Contribution

This study presents the first implementation of an after-hours nurse line for pediatric diabetes care in an academic setting.

## Key findings

- 70% of calls were handled by nurses without physician involvement.
- No patients sent home from the nurse line required emergency care afterward.
- Spanish-speaking parents used the service less than English speakers.

## Abstract

After-hours triage of pediatric patients by trained nurses improves consistency of triage decisions, access, and quality of care, and decreases burden on physicians on-call. There is a lack of published experience with this approach in the pediatric diabetes population.

An after-hours call service was established in September 2019 in our large urban pediatric teaching hospital. Barton Schmitt guidelines, which are widely accepted as the standard for telephone triage care, were modified to include institution specific diabetes management protocols. We analyzed demographics, reasons for call, clinical presentation to the emergency room, and clinical disposition of the callers.

The after-hours call service handled 70% of calls without physician involvement. There were no patients triaged to home care who subsequently required an emergency room visit or hospitalization. Patients who called the after-hours nurse line prior to coming to the emergency room were less sick and were discharged more often from the emergency room. Spanish-speaking parents utilized the service less than English speakers. There were no disparities in utilization based on the insurance status or race.

The after-hours service accurately triaged calls and reduced physician burden. Patients of all races and insurance statuses utilized the after-hours service equally well. Language was a barrier in the utilization.