Carbajal R, Barthez P, Blanc P, Paupe A, Lenclen R, Olivier-Martin M, Simon N
Département accueil-urgences, Centre hospitalier de Poissy, France.
Arch Pediatr. 1996 Oct;3(10):964-8. doi: 10.1016/0929-693x(96)81716-7.
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.
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.
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%).
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.
急诊科每天都要为儿童提供医疗电话咨询服务。为评估电话管理质量，采用了模拟一名4个月大发热女童且有败血症相关体征的虚拟场景。
随机挑选100家法国急诊科致电。一半医院设有床位超过20张的儿科；另一半医院没有儿科。一名研究技术员致电并说：“我的宝宝发烧了，我不知道该怎么办”。仅在被询问时才提供额外信息。
94家急诊科通过电话提供了医疗建议：65%的情况由医生提供，24.5%由护士提供，9.5%由护士技术员提供，1%由秘书提供。在没有儿科的医院，医生接听了76.5%的电话，而在设有儿科的医院，他们仅接听了53%的电话。每家急诊科平均询问的问题数为3.1个。87.2%的受访者询问了孩子的年龄。36.1%的急诊科在既未询问患者年龄也未询问发热程度的情况下就给出了建议。受访者给出的建议是：立即前往急诊科（30.9%）、立即看社区医生（51%）、明天前往急诊科（2.1%）、明天看社区医生（8.5%）以及在家处理（7.5%）。
本研究显示了一些急诊科在儿科电话咨询方面存在重大不足。这表明受访者在处理电话时未使用规范流程；迫切需要制定此类规范流程，以指导针对最常见电话咨询所进行的病史询问和建议提供。
