• Thomas J Lee, Larry J Baraff, Judith Guzy, David Johnson, and Heide Woo.
• Emergency Medicine Center, David Geffen School of Medicine, University of California, Los Angeles, USA.
• Arch Pediat Adol Med. 2003 Jul 1;157(7):635-41.

BackgroundAdvice nurse call centers are used to ensure access to medical advice, thereby potentially reducing the costs of health services.ObjectiveTo determine if medical advice from advice nurses and on-call physicians delays significant medical treatment in a general pediatrics population.DesignRandomized controlled trial.SettingA university general pediatrics faculty practice.ParticipantsParents or guardians calling for after-hours advice regarding their children.Intervention After-hours medical advice calls were randomized at the time of the call to an advice nurse or an on-call pediatrician.Main Outcome MeasuresThe proportion of callers who sought medical care not advised by the advice nurse or on-call pediatrician and the proportion who received unadvised significant care.ResultsThere were 1182 advice calls: 566 in the pediatrician group and 616 in the advice nurse group. There were no significant differences in the types of telephone triage advice in the physician and advice nurse groups. There was no significant difference in the proportion of callers who sought unadvised care (108 [19.9%] in the physician group vs 110 [19.0%] in the advice nurse group) or in the proportion of callers who received unadvised significant care (23 [4.2%] in the physician group vs 25 [4.3%] in the advice nurse group).ConclusionsThe proportions of callers who sought unadvised medical care and who received unadvised significant care were not significantly different in the advice nurse and pediatrician groups. This suggests that advice nurses do not delay significant medical treatment when compared with pediatricians.

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