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[Telephonic advice by an emergency department given in a simulated pediatric case]
R Carbajal1, P Barthez, P Blanc
1Département accueil-urgences, Centre hospitalier de Poissy, France.
Insights
Emergency departments provide inconsistent telephone advice for febrile infants. Many do not ask crucial details like age or fever severity, leading to inadequate pediatric care recommendations.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Healthcare Quality Assessment
Context:
- Emergency departments (ED) frequently provide medical telephone advice for children.
- Evaluating the quality of this telephone management is crucial for patient safety.
- A mock scenario of a febrile infant with potential septicemia was used to assess ED responses.
Purpose:
- To assess the quality of medical telephone advice provided by French emergency departments for a pediatric emergency scenario.
- To identify potential inadequacies in the information gathered and advice given during these calls.
Summary:
- Ninety-four emergency departments provided telephone advice, with physicians handling most calls.
- However, 36.1% of EDs gave advice without inquiring about the child's age or fever severity.
- Advice varied widely, from immediate ED visits to home management, highlighting inconsistencies.
Impact:
- The study reveals significant shortcomings in pediatric telephone advice from some EDs.
- It suggests a lack of standardized protocols for handling common pediatric telephone queries.
- Development of clear protocols is recommended to improve the quality and consistency of emergency telephone consultations for children.
Background:
Emergency departments (ED) are requested everyday to dispense medical telephone advice for children. To evaluate the quality of telephone management, a mock scenario simulating a febrile 4 month-old-girl with signs compatible with septicemia was used.
Methods:
One hundred randomly selected French emergency departments were called on. Half of the hospitals had a pediatric department with more than 20 beds; the other half did not have a pediatric department. A research technician called and said: "My baby has got fever and I do not know what to do". Additional information was given only on request.
Results:
Ninety-four ED gave medical advice by telephone: 65% of the cases by a physician, 24.5% by a nurse, 9.5% by a nurse technician and 1% by a secretary. In hospitals without a pediatric department, physicians took calls in 76.5% of the cases, whereas in hospitals with a pediatric department they only took calls in 53% of the cases. The mean number of questions asked per ED was 3.1. The age of the child was requested by 87.2% of the respondents. Advice was given by 36.1% of the ED without asking either the age of the patient or grade of the fever. The advice given by the respondents was: come to the ED immediately (30.9%), see a community physician immediately (51%), come to the ED tomorrow (2.1%), see a community physician tomorrow (8.5%), and manage at home (7.5%).
Conclusions:
This study has shown important inadequacies in pediatric telephone advice given by some ED. It suggests that the respondents do not use a protocol to handle the calls; development of such protocols to guide the histories taken and advice given for the most common telephone queries is urged.