It's late at night and a parent is concerned about his child's fever. Or it's 7 a.m. and a businesswoman is not sure if pain in her chest is indigestion or something more serious.
Such are the circumstances the Cleveland Clinic's Nurse on Call health information line was made to address.
Since its inception in 1991, the free consumer telephone service has provided medical assistance to nearly 320,000 callers. Although the clinic does not advertise Nurse on Call, word of mouth has helped the number of calls grow from 40,000 the first year to a projected 136,000 calls this year.
"Each year, the amount of calls we've received has increased about 33%," said Marilynn Breudigam, program manager. She said the service has answered calls from all 50 states, as well as Canada, Europe, Japan, Mexico and the Middle East. About 75% of the calls are from Ohio.
A team of clinic physicians, nurses and employees from the information systems and marketing departments conceived Nurse on Call as a pilot project in 1989. The goal was to use the service to provide medical information, health education and referrals to area physicians.
The 15-person staff, comprising registered nurses with at least 10 years of experience, uses computer-driven protocols developed by physicians to answer health questions, help callers determine the seriousness of their medical complaints and direct them to appropriate professionals.
Nurse on Call is available seven days a week, from 7 a.m. to 11 p.m.
"If we can't find the answer promptly, we will mail the information within 48 hours," Breudigam said. "For medication or dosage questions, we will contact local pharmacists.
"Our primary goal is to provide information," Breudigam said. "We consider ourselves the first line of triage. We try to focus on the symptoms, gather data and make recommendations." But the staff is not permitted to make formal diagnoses, in part to avert liability claims, she said.
The service has met no opposition from any part of the medical community.
"Physicians support the effort to provide the public with answers to questions about healthcare issues," said James F. Quilty, M.D., a pediatrician at MetroHealth Medical Center in Cleveland and chairman of public affairs for the Cleveland Academy of Physicians.
Breudigam said callers who ask for a physician referral are sent a list of clinic-affiliated doctors.
"I think they've done a smooth job of assessing caller complaints and directing the individuals to the proper physician," said Michael Mancuso, M.D., a Solon, Ohio, dermatologist. "I haven't had a wrong referral from Nurse on Call since the service started. They definitely help people to find the appropriate specialist."
Breudigam declined to specify Nurse on Call's budget, but she said the service doesn't make money. "We are a pure cost center," she said. "We're part of the Cleveland Clinic's mission to educate the community."
Nurse on Call staff member Tammy Scebbi said she recently handled a call from a parent who was concerned about an insect bite on her 2-year-old's eye. Among other recent calls was a woman, 36 weeks pregnant, who wasn't sure if she was in labor and a parent who needed advice about treating her daughter's fever.
"I've really improved my nursing skills," Scebbi said. "We can't use our eyes to see the caller's medical condition, so we have to use other assessment skills. In some cases, people just need to vent. We become a voice for the Cleveland Clinic."
Until two years ago Meridia Health System, based in Mayfield Village, Ohio, offered a similar health information line. The service, Ask-a-Nurse, was a national franchise that routed calls to nurses in California.
Karen Metropulos, director of planning and marketing for Meridia, said Ask-a-Nurse was dropped for budgetary reasons. It still operates Medline, a physician referral service.
"We decided it wasn't cost-effective to keep both services," she said.
Charlene Williams, a staff member who answered the first Nurse on Call inquiry four years ago, said the callers are split evenly among men, women, adults and children.
"We get all types of callers and a variety of medical complaints," Williams said. "I'm still learning. That's what makes the job interesting."
Crain News Service