• Eric Lee G Escobedo-Wu, Fouzel Dhebar, Griffith Harsh, Gary Steinberg, Alpa Vyas, Laurence Katznelson, Allen L Ho, Arjun V Pendharkar, Eric S Sussman, and Nidhi Rohatgi.
• Clinical Advice Service, Stanford Health Care, Stanford, CA.
• Ann. Surg. 2018 Apr 1; 267 (4): e67-e68.

ObjectiveThe aim of this study was to report the utilization and experience of the nurse telephonic triage service for after-hour patient calls in Neurosurgery.BackgroundIt is challenging for patients to reach their clinicians after-hours in a timely manner. This may result in worse health outcomes for the patients, or inappropriate utilization of emergency rooms and urgent care facilities. Physicians continue to remain overwhelmed with frequent after-hours calls in addition to other clinical responsibilities while on-call.MethodsIn August 2015, our institution launched the Clinical Advice Service (CAS) to provide a patient-centric, nurse-run telephone triage service for after-hour calls from Neurosurgery patients. Clinical protocols were created for use by CAS staff by Neurosurgery clinicians.ResultsBetween July 2016 and June 2017, CAS has accepted 1021 after-hours calls from Neurosurgery patients. A total of 71.4% of these calls were clinical, and the remaining nonclinical (directions, appointments, general information). CAS escalated 37.3% of the calls to the on-call Neurosurgery physician; 4.8% Neurosurgery patients were triaged to the emergency room by CAS.ConclusionCAS has been able to provide well-coordinated care to Neurosurgery patients while reducing physician workload.

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