Who Answers Pediatricians' "After Hours" Calls?
by Houston Family Magazine
Ask Amy — August 2010
Pink butterflies and flowers dance above the crib; the spinning mobile offset by the green walls of the nursery decorated especially for Leslie and Mark Buratti’s only child, Ella. It’s a room the new parents haven’t touched since October 30, 2009, when 4-month-old Ella stopped breathing.
“There was a lot of guilt,” Leslie said.”‘What did we do wrong? What did we do wrong?,’” she asked herself over and over in the weeks and months after Ella’s death. “Then, after talking to people and replaying it, what else are we supposed to do? We called her doctor. We trusted her doctor.”
Leslie and Mark called their pediatrician’s after hours phone number when little Ella came down with severe diarrhea. It’s called telephone triage; and many doctors offer it.
The Buratti’s pediatrician’s website claims, “One of our physicians is always on call. Call our office and the doctor or nurse will call you back.”
Naturally, the Burattis assumed the woman who returned their call was a nurse. Even as the couple dressed to drive their newborn to the emergency room, the woman on the other end of the line was calm and reassuring.
“And she said, ‘Just put a pacifier in her mouth,’” Mark recalls.
“She said, ‘You’re a first time mother, calm down,’” Leslie explained. “And then a phrase I’ll never forget was… she said, ‘If I were you, the last place I would take my baby was the emergency room.’”
The Burattis started to think they were overreacting, so they stayed home. Ella went to sleep. When the couple checked on her again, she wasn’t breathing. Doctors say she died of dehydration.
“The fact is we’re still trying to figure out who was this person in the middle of the night that dispensed this advice,” said Leslie. “Was she a nurse? Was she licensed? Who is this that we’re taking as a professional and trusting her advice?”
These are the questions telephone triage consultant Carol Rutenberg says every parent should be asking their pediatrician before an emergency.
“When you pick a pediatrician, find out who does triage,” Rutenberg said. “If someone identifies themselves as a nurse, ask them if they are an LVN (Licensed Vocational Nurse) or an RN (Registered Nurse).”
In Texas, you can earn an LVN degree in 1 year. An RN degree requires a minimum of 2 years of schooling; but Rutenberg says the biggest difference between the two is what their training allows them to do.
“RN’s are trained to do critical thinking, independent assessment and analysis,” Rutenberg explained.
The Texas Board of Nursing’s website states, “LVNs can only practice under the supervision of an RN, a nurse practitioner, a physician’s assistant, a physician, podiatrist or a dentist.”
The Burratis sued the doctor’s office. The lawsuit claims the “nurse” returned the panicked couple’s call from an apartment in northwest Houston. Nursing Board records show that woman was an LVN, who’s license had expired.
“The fact that the LVN was at home is irrelevant,” said Lynn Smith-Cronin, a Registered Nurse and a TeleHealth Manager. “The fact that she didn’t recognize that the baby was 3 hours from dying was the problem.”
Smith-Cronin says some doctors hire their own staff and put them on-call overnight. It costs much less to hire an LVN, or even a medical assistant with as little as 6 weeks of training, instead of an RN to answer late night calls.
Smith-Cronin says you should ask your doctor if the nurse assigned to telephone triage is dedicated to the phones or if they are multitasking, possibly caring for their own family at home while taking calls that could mean life or death for the baby in trouble on the other end of the line.
While doctors and nurses have returned the calls of worried parents after hours since the invention of the telephone, telephone triage has only been recognized as an organized specialty for about the last 15 years. Organizations like the American Academy of Ambulatory Care Nurses set standards and guidelines for doctors and nurses to follow; but there is no state or federal agency that requires doctors to meet any such criteria. It’s why Cronin-Smith says it’s up to you to do the research.
“You’ve got to think of your doctor as a mechanic. Don’t be intimidated to ask questions.”
In the end, Rutenberg and Cronin-Smith agree, parents should always trust your own instincts, no matter what advice you may get by phone.
“If you think your baby needs to go to the ER, you should take them,” said Rutenberg. “Never be reassured out of doing what you feel you should do.”
Ask Your Pediatrician:
- Who does Telephone Triage for your office?
- Are Registered Nurses or LVNs working the phones?
- Are nurses dedicated to the phones? Or are they working from home?
