Survey of telephone calls to tertiary paediatric neurology specialist registrars
- Correspondence to:
I Hadjikoumi
Department of Paediatric Neurology, St George’s Hospital, Blackshaw Road, London SW17 0QT, UK; ihatzikoumi{at}hotmail.com
Telephone consultations are an important means of delivering primary care to patients.1,2 However, minimal data are available on telephone advice provided by subspecialists at tertiary level. Due to the shortage of paediatric neurologists in the UK, telephone consultations via specialist registrars (SpRs) could be beneficial both for patient care and trainee experience.
We conducted a prospective study in the paediatric neurology department at St George’s Hospital, London, over 3 months from April to July 2006, of all day-time telephone calls to paediatric neurology SpRs. The paediatric neurology department is a tertiary service led by two consultants servicing an area with a population of 3.5 million and 12 district general hospitals. We have excluded direct phone calls to the paediatric neurology consultants and their secretaries. A documentation form was designed to record all information on the telephone calls including details of callers, patient’s demographics, problem, advice requested, educational value and outcomes. Calls were regarded as educational if factual knowledge was increased or clinical experience enriched. Outcomes included: (i) referrer’s satisfaction determined by a subsequent phone call and (ii) the need for admission to St George’s.
There were a total of 45 calls. Fourteen were from other departments within St George’s, 27 were from other hospitals, three were from parents and one was from a GP. Most external referrals were from a hospital lacking a paediatrician with expertise in epilepsy. Thirty calls came from SpRs and eight from senior house officers (SHOs). Monday was the busiest day (31% of calls). Twenty four calls related to known patients.
The most common presenting problem was epilepsy (15 cases, 33.3%), followed by newly developed seizures (seven cases) (fig 1). A study by Letourneau et al in a hospital based paediatric neurology clinic showed similar results (35.6%).3
Presenting problems.
The majority (39/45) of calls were of educational value. Caller satisfaction was 100% in the cases discussed with a consultant (41 cases). The remaining four cases were redirected to other centres due to lack of consultant cover.
Only three out of the 31 external referrals (10%) were admitted for neurological assessment. All were premature neonates with multiple longstanding problems resulting in difficulty with neurological assessment.
The number of telephone calls in our study is rather small (45 over 3 months) compared to the study by Cotton in an infectious diseases unit (359 calls in 2 months).4
Our calls were mainly from secondary level paediatricians (41/45). Not including the calls direct to consultants and secretaries may have resulted in some bias. The results of our study showed that the telephone advice service is effective in supporting paediatricians in the management of neurological cases and in improving the quality of patient care in local hospitals by reducing unnecessary transfers. The fact that most referrals came from hospitals with no epilepsy specialist cover reinforces the need in district general hospitals for specialists in epilepsy who would manage this group of children effectively.5 It also highlights the educational value of the telephone calls to the SpRs, indicating that telephone consultations may prove to be a new method of learning and professional development.
