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Continuity Clinic Notebook:
Preface and Introduction:
Reviews of Each Talk Given in the First 3 Quarters of 2001-2002
After-Hours Phone Calls - What Do You Do?
Chapter I. The
Prenatal and Well Child Visit:
The Prenatal Visit, Nursery and Well-Child Examination Issues
Chapter II. The Evaluation
of the Sick Children
Chapter III. Adolescent Issues
Chapter IV. Ethics, Dealing with Death
Chapter V. Other Aspects of Private
Practice, Business, Managed Care
Appendix: Well-Child Forms
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After-Hours Phone Calls - What do you do?
Introduction: When an after-hours call is answered by a resident
on continuity call, the resident should advise the parent with one of 3
responses: ER now, Appointment the next day, Phone advice only.
Residents should not defer the decision to the primary doctor the next day.
Clear-cut guidelines should always be given parents about when they should
call back. It is seldom necessary for the doctor to call the patient back
if this approach is followed.
If an intern is uncomfortable with the advice s/he is giving, after
checking with Dr. Barton Schmitt’s book, the resident should be asked for
help.
Sample Phone Calls: What questions should you ask, and what
disposition should you make:
- ER now, appointment the next day, advice only?
- 3 week old with temperature of 101 degrees. Acts normal. Mother
concerned about unrelated issue. Time of call: 4 AM. ER Now: r/o
sepsis
- 11 month old with “breathing hard” and fever to 101 degrees. Past
history of being ventilated for 2 1/2 months as ex-preemie. Time of call:
9:30 PM. ER now: r/o pneumonia
- 7 year old with chief complaint of peak flow meter reading of 160 (red
zone). Mother nurse and states that having difficulty breathing. Time of
call: 5:30 AM. Has meds at home. Appt
- 5 year old with sore throat and fever. 7-year-old sib had culture
positive strep diagnosed the day before. Mother wants you to call in
prescription. Time of call: 7 PM Friday night. Appt
- 14 month old with 6 episodes of vomiting and 6 episodes of watery
diarrhea in last 24 hours. Mother had put on Pedialyte; temp 101
degrees. Time of call: 10 PM. Advice only
- 23 month old with temp of 102 degrees and a shaking chill. Time of
call: 9 PM. ER now: consider pneumococcal sepsis.
- 3 year old who went to bed normal, awakens with excruciating abdominal
pain at 2 AM. Child is inconsolable. What should she do? Time of call:
2:10 AM. Advice: warm bath.
- 12 year old with constant cough; DM cough medicine given to no avail.
Advice: use asthma meds - if none at home, appointment next day.
- 2 week old with constipation; had been having 6-8 stools per day; No
stool in last 3 days. Advice: no need for treatment. If distended,
consider glycerin suppository.
Summary and Conclusion: Most phone calls should be focused and
brief. It should not be necessary to spend more than 5 minutes on a call.
The formal of the telephone triage card should be followed and one of 3
pieces of advice given:
- ER now: an emergent visit that cannot wait until morning
- Appointment the next day: you will need to decide whether the child
can wait until the afternoon clinic time or needs to be seen in the AM
clinic.
- Phone advice only: non-serious. Problem can be handled by advice or
wait until the next scheduled visit.
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