How 24-hour helplines may be sending more patients to the hospital

More large insurers appear to be using 24-hour helplines to provide patients with clinical advice, but they may serve only to send more patients to the emergency room unnecessarily, Fred Pelzman, MD, wrote in an opinion piece published July 24 on MedPage Today.

Some patients are calling these lines with minor cuts and bruises while others call for heart attacks, strokes and serious falls. The clinicians answering the phones follow algorithms and decision trees designed "not to miss the badness that's out there," Dr. Pelzman wrote. The algorithms were created with the input of physicians, but without the relationship or medical history of the patient, there is little clinicians can do besides send people to hospitals.

Dr. Pelzman, of Weill Cornell Internal Medicine Associates in New York City, wrote, "At first blush, it feels like a really nice service to have — one more opportunity for patients to get medical advice and safely make it through the night, or the weekend or their vacation. But … most of them seem to end up with the person giving the clinical advice recommending that the patient go into the emergency department so as not to miss some terrible outcome."

Dr. Pelzman wrote that if companies can find a way to expand care so patients can get answers without being sent to the emergency room, that would be the ideal scenario. Improved telemedicine, remote patient monitoring and video visits also could fill this gap.

"Truly patient-centered care would help find a way to keep the patient within the system that they call home, where their primary care provider lives, where all of their specialists live, and where everyone can put in their two cents whenever it's needed," he wrote. "True, there will always be off-hours emergencies: strokes, heart attacks, and diabetic ketoacidosis don't always stay within the confines of the 9-to-5 day. But if we can enhance, improve and deepen the care and strengthen the bonds between patients and their providers, we can certainly go a long way to making them less likely to call during off-hours."

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