Optimizing the use of telephone nursing advice for upper respiratory infection symptoms.

Objective: To describe efforts to optimize telephone self-care advice for upper respiratory infection (URI) symptoms by registered nurses in Kaiser Permanente Northern California's Appointment and Advice Call Center, and to assess the sufficiency of this advice.

Methods: Retrospective observational study. Methods: The study sample included 279,625 calls from adults 18 years and older that resulted in self-care advice for URI symptoms in 2009. Utilizing electronic medical records of these calls and follow-ups, we determined the rate of return calls within 7 days and the clinical outcomes associated with these. Advice for self-care at home was considered sufficient if no return calls received within 7 days of the original call were associated with the need for a "higher" level of care, such as an appointment.

Results: Self-care advice was sufficient for 88% of index advice calls, with either no follow-up calls within 7 days associated with a higher level of care, or follow-up calls only for additional advice or nonmedical information.

Conclusions: Telephone advice for self-care by registered nurses can effectively manage URI symptoms for most otherwise healthy adults.