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Professional telephone advice to parents with sick children: time for quality control!
J K Andrews1, K L Armstrong, J A Fraser
1Riverton Centre, Community Child Health Service, Royal Children's Hospital & Health Service District, Nathan, New South Wales, Australia.
Insights
Professional telephone advice for sick children is accessible but often inappropriate, posing risks to child health. Improved quality control and centralized advice lines are crucial for ensuring accurate medical guidance.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Telehealth Services
Background:
- Parents frequently seek medical advice for sick children via telephone.
- Assessing the quality of this advice is critical for patient safety.
- Existing telephone advice services vary in structure and oversight.
Purpose of the Study:
- To evaluate the quality and appropriateness of professional telephone advice provided to parents regarding pediatric health concerns.
- To identify deficiencies in current telephone advisory services for pediatric cases.
Main Methods:
- A study involving simulated calls to hospital-based telephone advice lines in Brisbane, Australia.
- Standardized case scenarios (febrile infant, gastroenteritis, head injury) were presented to assess advice quality.
- Key metrics included response time, advice-giver profession, information gathered, and advice provided.
Main Results:
- Only 68.5% of calls correctly identified the urgency of the presented pediatric cases.
- The febrile infant scenario was least likely to elicit appropriate urgent advice (39%).
- Doctors provided more accurate advice than nurses for fever cases, but not consistently for other scenarios.
Conclusions:
- Telephone advice for sick children is readily available but frequently inadequate and potentially dangerous.
- There is a significant need for enhanced quality control mechanisms for pediatric telephone advice.
- Consideration should be given to establishing centralized telephone advice lines for improved consistency and safety.
Objective:
To assess the quality of professional telephone advice given to parents with sick children.
Methods:
All hospitals with an emergency department and a paediatric ward and a designated child health telephone advice line in the greater Brisbane region were invited to participate in the study. Case scenarios involving a febrile baby, a 14-month-old with gastroenteritis and an 18-month-old with a head injury were used three times with each institution. Each of the cases should have elicited a response indicating the need for urgent medical attention. A research assistant presented the symptoms in accordance with the questions of the telephone advice-giver. Aspects of the call were recorded, including time between call made and access to advice-giver, profession of advice-giver, identifying details sought by advice-giver, questions asked about the case presented, length of call, and advice-given.
Results:
Of the 10 hospitals asked, six agreed to participate. Included in the study were two paediatric hospitals, two general public hospitals, one private hospital, and a Statewide-designated child health telephone advice line. Calls were generally attended to promptly. Only 37 (68.5%) of the advisers recognized the urgency of the case scenarios, with the febrile infant having the least likelihood of eliciting the correct advice (39%). Doctors gave more reliable advice than nurses in the fever scenario, but not in the other cases.
Conclusions:
Telephone advice to parents with sick children is easily accessible, but is often dangerously inappropriate. There is a need for tighter quality control and/or for a centralised telephone advice line to prevent inappropriate advice being given to parents.
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