PEDIATRIC TELEPHONE ADVICE TO A MOCK SCEN ARIO IN THE EMERGENCY DEPARTMENT

Background. - Emergency departments (ED) are requested everyday to dis pense medical telephone advice for children. To evaluate the quality o f telephone management, a mock scenario simulating a febrile 4 month-o ld-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 b eds; the other half did not have a pediatric department. A research te chnician called and said ''My baby has got fever and I do not know wha t 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 too k calls in 76.5% of the cases, whereas in hospitals with a pediatric d epartment 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 advic e given by the respondents was: come to the ED immediately (30.9%), se e a community physician immediately (51%), come to the ED tomorrow (2. 1%), see a community physician tomorrow (8.5%), and manage at home (7. 54%). Conclusions. - This study has shown important inadequacies in pe diatric telephone advice given by some ED. It suggests that the respon dents do not use a protocol to handle the calls; development of such p rotocols to guide the histories taken and advice given for the most co mmon telephone queries is urged.