Assessment of Gynecologic Emergency Triage and Appointment Wait Times: A Mystery Caller Study.

BACKGROUND

Front desk staff are often responsible for triaging patients, despite lacking formal medical training. Incorrect triage recommendations could result in patients delaying care for emergent conditions. No research exists to characterize triage accuracy in the gynecologic outpatient setting.

OBJECTIVE

We investigated the ability of clinician office staff to identify emergent conditions and advise patients accordingly. Additionally, we sought to understand the influence of private versus public insurance on appointment wait time and triage recommendations.

STUDY

DESIGN

Obstetrician-gynecologist (OB/GYN) office phone numbers were identified from the Centers for Medicare and Medicaid Services National Practice and Provider Enumeration System and contacted using a covert mystery caller study approach. Half of the calls described a gynecologic emergency that required immediate intervention, while the other half described a gynecologic condition that required urgent evaluation. In the "Emergent" scenarios, callers described a positive pregnancy test after tubal ligation or a tubo-ovarian abscess. In the "Urgent" scenarios, callers described a urinary tract infection or recurrent vaginitis. The date of the soonest appointment and triage recommendations were recorded.

RESULTS

Our sample included 1,114 calls to 557 unique physician offices from 48 states (excluding North Dakota and Rhode Island). Of the physician offices contacted, 371 physicians met the inclusion criteria. In this sample, 75.2% of OB/GYN offices accepted Medicaid. The median physician age was 53 (IQR 44-61), and almost two-thirds (63.2%) of physicians contacted were female. A total of 142 callers were instructed to seek emergency care, transferred to a nurse triage line, or offered provider consultation. Of Emergent scenario callers, 21.5% (n = 60/N = 279) were correctly triaged. Eighty-two of the 279 Urgent scenario callers (29.4%) were incorrectly instructed to seek emergency care. There was no significant difference in appointment wait time or triage recommendation based on insurance. Calls to female physicians were associated with shorter wait times (p < 0.01), while academic physicians (p < 0.01) and longer call hold times (p = 0.04) were associated with longer wait times. Wait times varied significantly between clinical scenarios.

CONCLUSIONS

To the best of our knowledge, this is the first nationwide audit of OB/GYN office staff patient triage. Our results revealed that patients are often incorrectly triaged and offered future appointments for emergency conditions that require immediate attention. Faulty triage results in significantly delayed treatment, which can impede patients' future fertility or threaten their lives. We propose the development of a standardized resource to increase telephone triage accuracy and minimize patient harm.