Professional telephone advice to parents with sick children: time for quality control!

Abstract

To assess the quality of professional telephone advice given to parents with sick children. All hospitals with an emergency department and a paediatric ward and a designated child health telephone advice line in the greater Brisbane region were invited to participate in the study. Case scenarios involving a febrile baby, a 14-month-old with gastroenteritis and an 18-month-old with a head injury were used three times with each institution. Each of the cases should have elicited a response indicating the need for urgent medical attention. A research assistant presented the symptoms in accordance with the questions of the telephone advice-giver. Aspects of the call were recorded, including time between call made and access to advice-giver, profession of advice-giver, identifying details sought by advice-giver, questions asked about the case presented, length of call, and advice-given. Of the 10 hospitals asked, six agreed to participate. Included in the study were two paediatric hospitals, two general public hospitals, one private hospital, and a Statewide-designated child health telephone advice line. Calls were generally attended to promptly. Only 37 (68.5%) of the advisers recognized the urgency of the case scenarios, with the febrile infant having the least likelihood of eliciting the correct advice (39%). Doctors gave more reliable advice than nurses in the fever scenario, but not in the other cases. Telephone advice to parents with sick children is easily accessible, but is often dangerously inappropriate. There is a need for tighter quality control and/or for a centralised telephone advice line to prevent inappropriate advice being given to parents.