Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Pediatrics. 2012 May;129(5):961-7. doi: 10.1542/peds.2012-0146. Epub 2012 Apr 23.

2011 Joseph W. St Geme Jr lecture: five things I'd like to see changed in American pediatrics, five lessons I've learned.

Author information

  • Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX 75390-9063, USA. george.lister@utsouthwestern.edu

Abstract

OBJECTIVE:

In response to limitations in access to subspecialty care, I present personal observations and suggestions related to education of future pediatricians regarding development of critical thinking skills, care of complex and chronically ill patients, development of empathy, and restoration of responsibility that may help ameliorate this serious problem. Toward this end, I also offer 1 approach, a 24/7 telephone consultation network, for enriching interaction of primary care providers (PCPs) and subspecialists who can potentially provide rapid access to needed advice, reduce demand for subspecialty appointments, bolster decision-making and expertise, and realign resources with need.

METHODS:

Data were obtained from 579 requests by PCPs for telephone consultation by subspecialists in 8 areas (including child psychiatry).

RESULTS:

Of calls, 27% took <5 minutes and 79% took 5 to 15 minutes. Of calls, 28% resulted in a clinic visit; 8% prompted hospital transfer, hospital admission, or referral to an emergency department; and the remaining 64% resulted in continued management by PCP with reinforcement of the plan. Assuming most inquiries would have resulted in referral to a subspecialist were there no telephone consultation, we estimated that 70% (8+64%) of consultations realigned resources with need, resulting in large saving of unnecessary clinic visits, travel, expense to families, lost days at work, or missed school.

CONCLUSIONS:

Development of rapid telephone consultation networks could provide increased access to care for those children in greatest need, use limited resources more efficiently, foster collegial and productive relationships between medical providers, and increase expertise of PCPs and subspecialists.

PMID:
22529277
[PubMed - indexed for MEDLINE]
Free full text
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire
    Loading ...
    Write to the Help Desk