Telephone consultations in child neurology practice: number and contents
Introduction. The workload of telephone consultations has been scarcely studied except at the Emergency Units, in spite of the considerable amount of time consumed by the task in normal practice. Objective. To asses the workload of telephone consultations in a Neuropediatric Unit, during normal working hours. Methods. A prospective analysis ofall calls received during a year, at the out-patient hospital-based neuropediatric clinic. Results. 150-200 telephone consultations were received every month, decreasing during the holiday seasons. They amount to two thirds of the face-to-face contacts at the clinic, during the same period of time, and require about 10% of our day-time working hours. Disorders more likely to produce the calls: epilepsy (40%), mental retardation (19%), cerebral palsy (11%), all others with a frequency lower than 5%. These percentages, and those of hydrocephalus, autism and spina bifida, are similar to those encountered in normal practice, while headaches, speech delay, hyperactivity, syncopes, etc. produced half the number of calls expected; myopathies doubled the number of calls expected. The monthly frequency of calls varied significatively, along the year, for epilepsy, mental retardation, hyperactivity, migraine and autism. Calls were made especially by the family (49%), but it depends of the purpose and the patient’s diagnosis. The purpose was most frequently to consult about the symptomatology of the illness; treatments produced 7% of calls; and discussion about citations, 19.5%, regardless of the diagnosis. Conclusion. In neuropediatric practice, telephone consultations should be recognized and provided for in order to manage effectively the clinical demand.
Objetivo Estudiar el volumen y contenido de las consultas telefónicas en una Unidad de Neuropediatría hospitalaria. Métodos. Análisis prospectivo de todas las llamadas recibidas durante un año en la consulta, dentro del horario normal de trabajo.
Resultados Se reciben 150200 llamadas mensuales, que disminuyen en épocas vacacionales. Constituye un volumen asistencial equiparable a dos tercios de las consultas de presencia física, durante el mismo período, y ocupan aproximadamente el 10% de la jornada laboral habitual. Los procesos que ocasionan más llamadas son: epilepsia (40%), retraso mental (19%), parálisis cerebral (11%); la frecuencia de los demás es inferior al 5%. Estos porcentajes, y los de hidrocefalia, autismo y espina bífida, son similares a los encontrados en la consulta, mientras que las llamadas por cefaleas, disfasias madurativas, hiperactividad, síncopes, etc., tienen un porcentaje la mitad de lo esperado; las miopatías producen el doble de llamadas respecto a lo esperado. Hay cinco diagnósticos que influyen significativamente sobre la frecuencia mensual de llamadas: epilepsia, retraso mental, hiperactividad, migraña y autismo. Llama sobre todo la familia (49%) pero depende del motivo y del diagnóstico. El motivo principal es la sintomatología de la enfermedad; el tratamiento ocasiona el 7% de las llamadas, y las citas el 19,5%, independientemente del diagnóstico.
Conclusión En nuestra especialidad es conveniente reconocer y formalizar este aspecto de nuestro trabajo, si queremos gestionar eficazmente la demanda