PURPOSE: Children requiring invasive mechanical ventilation are at risk for significant pulmonary compromise due to their ventilator requirement. Local providers are frequently unfamiliar with management of intermittent pulmonary exacerbations. Therefore, a phone triage program was implemented to allow these families to contact the program based PNP for assessment and intervention.
METHODS: Retrospective review of phone triage records in the 120 day study period from January to April 2006. Subjects were patients of the University of Michigan Health System Pediatric Home Ventilator program and required invasive mechanical ventilation via a tracheotomy. Eligible records included phone calls received within the study period with the chief complaint related to a respiratory symptoms. All calls were received by the Pediatric Home Ventilator Program phone line and were triaged by the RN or the PNP. If the call was answered by the RN, the case was discussed with the PNP prior to diagnosis and implementation of a plan.
RESULTS: Over the study period 102 calls met criteria for inclusion with an average of 25 calls per month. Calls lasted an average of 16 minutes with a range of 14 to 18 minutes per call. 20 of the calls (5%) required prescription of additional medication. 50 of the calls required adjustment of existing medication. 3 of the calls required referral to the emergency department and 1 of the calls required office visit at the specialist office.
CONCLUSION: Phone triage by a PNP/RN team is a cost effective and efficient mechanism to treat pulmonary exacerbations in a chronic home ventilator population. This preliminary study supports the significant savings these services can provide for the third party payors and reduce cost burden on the health care system.
CLINICAL IMPLICATIONS: Phone triage of pulmonary exacerbations is safe,effective and worth consideration in chronic populations in which locally based caregivers may not have sufficient expertise to treat and may require frequent calls/visits to the pulmonolgist. This model optimizes the time utilization of pediatric pulmonologist by delegating this function to PNP/RN team.
DISCLOSURE: Ann Marie Ramsey, No Financial Disclosure Information; No Product/Research Disclosure Information