Using Video Transmission for Optimized Telephone Triage of Children With Fever at the Medical Helpline 1813 in Copenhagen, Denmark

Background Each year, the Copenhagen Emergency Services receives approx. 190,000 calls to the Medical Helpline 1813 regarding sick children younger than 12 years (injuries excluded). These children are not so sick that the parents call 112, but the parents need to get in contact with the health services outside their general practitioners' (GP) opening hours.

The health professionals at 1813, have several options after the conversation with the parent. They can for example admit the children at a Pediatric Emergency Department (PED), refer them to assessment in a pediatric urgency care clinic (Børnelægevagten), guide the parents in care for the child (self-care), or advise them to see their GP the next working day. Of the 190,000 calls annually regarding sick children, the majority is concerning young children; in 2018, just over 175,000 of the calls concerned children under the age of 6. Approx. 30% of these children were referred to assessment in a pediatric urgency care clinic. Most of these children reveal to have quite mild symptoms, and most are sent back home with good advice after an assessment by a doctor.

Phone triage is difficult, especially when the operator does not know the child nor the parents, and it may be difficult to describe symptoms with words. Many visits to the pediatric urgency care clinic can be perceived as unnecessary and inappropriate for the sick child and its parents, whom, with advice and proper guidance could have stayed at home. Moreover, the visits are expensive for the health system.

A Danish study, which was conducted the first year after the 1813 helpline was launched, showed that most calls concerned children aged 0-1 years and that the calls seldom were about serious conditions. The author interpreted the results as if the parents were primarily calling 1813 to feel safe about the child's condition.

In a Danish study from 2013, 28% of the urgent inquiries outside the GP's opening hours concerned just 2.5% of the children. These children had at least 4 of such urgent inquiries in one year. The median age of these children was 2.9 years old, as compared to 7.3 years in the whole group of children. The five most common working diagnoses among the children with many contacts were acute bronchitis, viral disease, seizures (not classified elsewhere), abdominal pain and gastroenteritis, that is, conditions where children are likely to have a fever. The authors mention that fever in itself causes many contacts to the health services and that the parents are very concerned about fever, which is also shown in several international studies.