Algorithm-directed care by nonphysician practitioners in a pediatric population. Part II. Clinical outcomes, patient satisfaction, and costs of care.

We compared outcome and cost of care for 2234 pediatric patients with upper respiratory tract infections cared for by nonphysician practitioners and 304 similar patients cared for by pediatricians. We found no significant differences (p greater than 0.05) between nonphysician practitioners' patients and pediatricians' patients in the status of the original symptoms, the number of patients reporting new symptoms, the number of return visits, or the reasons for return visits. Approximately 93 per cent of both groups had no complaints about their care. Medication costs were higher for Pamosists than pediatricians, but lower labor costs caused Pamosist care to be 15.5 per cent ($2.64) less expensive than pediatrician care in this setting, even when the costs of Pamosist audit by computer were included. Through use of clinical algorithms with computer audit, relatively untrained nonphysician practitioners can deliver safe, cost-effective health care to pediatric patients with upper respiratory infections.

Algorithm-directed care by nonphysician practitioners in a pediatric population: Part I. Adherence to algorithm logic and reproducibility of nonphysician practitioner data-gathering behavior.

The ability of quickly trained nonphysician practitioners to care for pediatric patients with upper respiratory tract infections (URIs) was evaluated in 3802 patients. These nonphysician practitioners (Army Pamosists) used an explicit treatment protocol and computerized audit of protocol adherence. Pamosists omitted protocol-suggested plans in 3.7 per cent of cases and ordered unnecessary treatment plans in 1.7 per cent of cases. They did not obtain a suggested MD consultation in 6.2 per cent of the cases. Agreement between Pamosists and pediatricians on data and management decisions (PM-MD study) was then compared with agreement on the same variables between pairs of a group of five pediatricians who saw a separate but comparable group of 103 pediatric URI patients (MD-MD study). The Pamosists demonstrated good (77 to 89 per cent) overall agreement with pediatricians, and the amounts of agreement between Pamosists and pediatricians in the PM-MD study did not generally differ significantly (p greater than 0.05) from the agreement on the same variables between pairs of pediatricians in the MD-MD study.

Computerized triage of pediatric patients: automated triage algorithms.

Pediatric triage algorithms which were prospectively and retrospectively validated in a pediatric acute care facility serve as the basis for the development of a simplified pediatric triage checklist. This checklist is used by minimally trained nonprofessionals to assign safely the care urgency categories of the chief complaints of pediatric "walk-in" patients. This article describes the background of the pediatric triage checklist and its adaptation to a computerized triage system. This system not only allows for safe triage, but also creates a mechanism for rapid, organized retrieval of data from individual and group patient triage encounters that is useful for the study and planning of health care delivery.

Algorithm-directed triage in a pediatric acute care facility: a retrospective study.

Algorithm-directed triage by nonprofessionals was used to safely assign care urgency categories to 22,934 walk-in patients under 13 years of age during 1978. Of all patients, 16.7% were categorized as having urgent or potentially urgent problems at triage. Of those patients admitted, 79.12% received these urgency classifications. Additionally, 72.13% of all patients received an acute minor illness care urgency classification. Of patients admitted, 20.87% had an acute minor illness classification. A total of 11.16% of all patients received a routine or non-urgent classification. No patients admitted had been triaged to this non-urgent classification. As determined by review of records of 91 patients admitted from the acute care facility, the system safely identifies both high- and low-risk walk-in populations.

Algorithm-directed triage of pediatric patients. A prospective study.

An Army corpsman used physician-written triage algorithms to rate the urgency of the chief complaints of 2,000 pediatric outpatients. His ratings agreed with subsequent ratings by physicians in 84% of cases. The corpsman assigned a higher care urgency classification in 15% of cases and a lower classification in only 1.2% of cases. No danger to patients resulted from the algorithm-directed screening. Use of a "nonprofessional" as a triage agent spares the pediatrician, pediatric nurse practitioner, and nurse for providing health care. With increasing use of acute care facilities by patients without appointments, physician-written algorithms allow triage agents who lack formal medical training to determine safely the need for care of patients.