Using Video Transmission for Optimized Telephone Triage of Children With Respiratory Symptoms at the Medical Helpline 1813 in Copenhagen, Denmark
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 734
- 试验地点
- 1
- 主要终点
- Disposition
研究概览
简要总结
Background
The medical helpline 1813 in Copenhagen, Denmark handles telephone calls regarding non-life-threatening medical emergencies. Next to 200,000 calls/year concern children and afterwards about 30% are referred to a pediatric urgent care center. However, most of these children have very mild symptoms, which do neither require treatment nor any tests, but merely parental medical guidance.
Initial assessment; triage, of children on the telephone is difficult, especially when the operator does not know the child or the parents, and when it is difficult to describe the symptoms in medical terms. This may result in both too many not-so-sick children getting unnecessarily referred to hospitals, and perhaps also too few more severely sick children sent to the hospital.
Purpose
This project will study if triage of children by videocalls (video triage) provide greater security for parents and health care personnel in the decision that more children can stay at home after medical guidance, thus causing at least 10% fewer visits to a pediatric urgent care center.
Furthermore, the investigators will study if video triage identifies more children with the need of urgent admission to a Department of Pediatrics.
Method
Children aged 6 months to 5 years with symptoms from the respiratory tract will be triaged by either video or telephone by an operator every other day, in order to compare the results between these two similar groups. In cases of video triage, the parent will receive a text message to their smartphone with a video link.
The safety of video triage will be assessed by reviewing the hospital case reports of all patients for contact within the 48 hours after the 1813 call.
Perspectives
Video assessment at call centers may "give eyes to the operators" and revolutionize telephone triage. The study may result in fewer children referred to hospitals, more appropriate use of resources and better experiences for the families.
详细描述
Background
Each year the Copenhagen Emergency Services receives approximately 190,000 calls to the medical helpline 1813 regarding sick children younger than 12 years (injuries excluded) (Rasmussen MV, ref. 1). These children are not so sick that the parents call the emergency helpline 112, but the parents need to contact the health care system outside their general practitioners' (GP) opening hours.
After contact with the parents the medical helpline 1813's health professionals have several possibilities for the children; e.g. admitting the children to a Department of Pediatrics, referring them to assessment in Børnelægevagten (a pediatric urgent care center), guiding them to self-care at home, or referring them to their GP the next workday.
Of the 190,000 calls annually regarding sick children, the majority of the calls concerns small children; in 2018, about 175,000 of the calls concerned children younger than 6 years. About 30% of these children were referred to assessment in a pediatric urgent care center. Most of these patients have mild symptoms which do neither require treatment nor paraclinical testing, but merely parental medical guidance. These consultations can be experienced as unnecessary and inappropriate for the sick child and its parents. Moreover, the visits are expensive for the health system.
Telephone triage is difficult, especially when the operator does not know the child or the parents, and when it is difficult to describe symptoms in medical terms. Telemedicine, i.e. the use of communication- and information technology within the healthcare system, is gaining increasing influence in the medical society, also within pediatrics (Olson CA et al, ref. 2). The American Academy of Pediatrics has urged both general pediatricians and pediatric subspecialists to use telemedicine to serve more children (Marcin JP et al, ref. 3).
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- None
入排标准
- 年龄范围
- 6 Months 至 5 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Symptoms presented to the 1813 operator categorized as: coughing/breathing difficulties, cold or suspected influenza.
- •Parents are calling from a smartphone with Apple, Windows or Android operating system.
排除标准
- •The child has already participated.
- •The parent does not call from a Danish telephone number.
结局指标
主要结局
Disposition
时间窗: disposition is registered by the call operator immediately after the call.
difference between the two arms in the percentage of children that can stay at home the day the parents call 1813, i.e. referral to self-care or GP, compared to the control group.
次要结局
- Admission(disposition is registered by the call operator immediately after the call.)
- Nurses' satisfaction: percentage of nurses that were satisfied(the nurses fill out a questionnaire about the call immediately after each call.)
- Technical difficulty, nurses(the nurses fill out a questionnaire about the call immediately after each call.)
- Parents' perception of getting answers to their questions(the parents are sent a link to an online questionnaire immediately after the call to 1813.)
- Safety of disposition choice: percentage of duration of admission(the hospital charts of all children are read within 2-8 days after the call.)
- Technical quality of the video call(the nurses fill out a questionnaire about the call immediately after each call.)
- Disposition choice(the nurses fill out a questionnaire about the call immediately after each call.)
- Hospital visits(the hospital chart of all children are read within 2-8 days after the call.)
- Economy(the number of visits to hospitals in each arm will be studied at the completion of enrolling patients.)
- Parents' satisfaction about assessment: percentage of parents that felt safe about the assessment(the parents are sent a link to an online questionnaire immediately after the call to 1813.)
- Parents' satisfaction about the plan for the child: percentage of parents that felt safe(the parents are sent a link to an online questionnaire immediately after the call to 1813.)
- Parents' satisfaction about the call: number of parents in the two arms who were satisfied(the parents are sent a link to an online questionnaire immediately after the call to 1813.)
- Technical difficulty, parents(the parents are sent a link to an online questionnaire immediately after the call to 1813.)
- Non-participating parents(these parameters will be studied at the completion of enrollment of patients.)
研究者
Caroline Gren
MD
Emergency Medical Services, Capital Region, Denmark