Scientific Letter
Organisation and assessment of urgent paediatric telephonic hospital care during the COVID-19 pandemic
Organización y valoración de la atención telefónica urgente hospitalaria pediátrica ante la pandemia COVID-19
Jara Gaitero Tristán
, Marta Bascuas Arribas, Clara Luna Parera Pinilla, Raquel Jiménez García
Corresponding author
Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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A: FiO<span class="elsevierStyleInf">2</span> > 35% predicts severe MAS with a sensitivity (Sen) of 93% and a specificity (Spe) of 72%; FiO<span class="elsevierStyleInf">2</span> > 65% showed a Sen of 73% and a Spe of 93% for severe MAS, with an area under the curve (AUC) of 0.93 (95% confidence interval [CI], 0.85–1). B: A pH at admission <7.22 was associated with severe MAS, with a Sen of 71.4% and a Spe of 75%; a pH at admission <7.12 was associated with severe MAS with a Sen of 50% and a Spe of 91.7%, with an AUC of 0.789 (95% CI, 0.616–0.962). 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Due to the extraordinary increase in the demand for adult emergency care and the low impact on paediatric services, the Community of Madrid reorganised paediatric care, centralising paediatric emergency care preferentially in 2 tertiary care hospitals between March 21 and May 6.</p><p id="par0010" class="elsevierStylePara elsevierViewall">During this period, telemedicine was one of the tools used by health care providers to facilitate the management and follow-up of patients with COVID-19 or with chronic diseases (such as diabetes or psychiatric disorders).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In light of the new situation involving the lockdown, the reduction in the centres offering paediatric care and the overwhelming demand for health care call lines by adult patients, the hospital organized a new urgent call line for the paediatric population (age < 18 years).</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of our study was to describe the organization of urgent telephonic paediatric care offered from the hospital setting during the COVID-19 pandemic and learn how the service is perceived by health providers involved in its delivery.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We performed a descriptive study with collection of data between March 20 and May 3 at the Hospital Universitario Infantil Niño Jesús. During this period, phone calls received by the hospital switchboard seeking medical consultation were transferred to the personal mobile phone of the on-call paediatrician, facilitating distance work. The line was operative between 8<span class="elsevierStyleSmallCaps">am</span> and 9<span class="elsevierStyleSmallCaps">pm</span>, 7 days a week. Daily shifts (morning/afternoon) were assigned through the Doodle scheduling tool, staffing each shift with 2 or 3 paediatricians. Paediatricians took the patient history by telephone and requested complementary photographs and videos to be submitted to the hospital email address. If needed, the paediatricians wrote prescriptions through the prescription system of the official board of physicians of Madrid. For the first week of telephonic care, we collected data on the reasons for consultation and the need for referral to the emergency department.</p><p id="par0030" class="elsevierStylePara elsevierViewall">At the end of the telephone care programme, we made an anonymous survey of the providers that staffed the call line through an online questionnaire comprised of 13 items (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The service received 1899 calls (a mean of 42 a day). We analysed the reasons for consultation for the 270 calls received in week 1: respiratory infection with fever (33.3%), fever without source (12.9%), gastrointestinal symptoms with vomiting and/or diarrhoea (9.3%), cutaneous lesions (9.3%), falls/accidents (5.5%), health-related questions (newborn care and vaccines) (7.4%), questions regarding COVID-19 (5.7%) and other (16.6%). Twenty-one percent of patients were referred to the emergency department, and the most frequent reason for referral was breathing difficulty, followed by fever without source.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Of the total of 52 physicians that staffed the call line, 32 participated in the survey (response rate, 60%). The median age of participants was 32 years (interquartile range [IQR], 27–44), 48% had less than 5 years of experience, 10% 5 to 10 years of experience and 37% more than 15 years. Also, 58% had worked in primary care in the past and 83% did on-call shifts in the emergency department. The median of shifts they covered in the call line was 4 (IQR, 2–7).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ninety percent of respondents considered that urgent telephonic care was useful to identify patients that required referral to the emergency department, and 97% that it was useful to resolve other types of medical concerns. Also, 93.5% believed that audiovisual media was helpful. Only one physician reported low confidence in delivering care by telephone (3/10), while 73.6% of respondents gave this item a score of 8 out of 10. In terms of their perception of patients, 32% of paediatricians reported that parents seemed reluctant to leave the house to visit the emergency department and 55% believed that parents had used the telephone services appropriately. As many as 93.5% scored the usefulness of telephonic care during the pandemic at 8/10 or higher, and 64.9% would agree with prolonging this service.</p><p id="par0050" class="elsevierStylePara elsevierViewall">During the crisis of the COVID-19 pandemic, our hospital established an urgent telephonic care service for the paediatric population staffed by the paediatricians of the centre in different shifts. The providers considered the service useful to identify patients that required urgent referral and to resolve health-related concerns. The respondents had a very positive opinion of this telemedicine tool.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gaitero Tristán J, Bascuas Arribas M, Parera Pinilla CL, Jiménez García R. Organización y valoración de la atención telefónica urgente hospitalaria pediátrica ante la pandemia COVID-19. An Pediatr (Barc). 2021;94:335–336.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Items \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Answers \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Age in years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2. Years of experience as a paediatrician \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 5 years 5−10 years 10−15 years >15 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3. Do you do on-call shifts as part of your usual practice? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4. Have you ever worked in primary care? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes/No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5. Write the number of shifts you have done in the phone care service: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6. Phone services are useful to identify patients that require emergency care on site: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strongly disagree - Disagree- Neither agree nor disagree- Agree - Strongly agree \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7. Telephone service was useful to resolve medical concerns of parents regarding conditions that did not require emergency care: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strongly disagree - Disagree- Neither agree nor disagree- Agree - Strongly agree \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8. Audiovisual media (sending images and/or videos through email) have been useful: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strongly disagree - Disagree- Neither agree nor disagree- Agree - Strongly agree \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9. In the case of patients referred to the emergency department, the parents expressed reluctance to leave the house: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strongly disagree - Disagree- Neither agree nor disagree- Agree - Strongly agree \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10. In your opinion, patients used the urgent line appropriately: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strongly disagree - Disagree- Neither agree nor disagree- Agree - Strongly agree \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11. Do you think it would be useful to maintain telephonic care after the COVID-19 pandemic? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Strongly disagree - Disagree- Neither agree nor disagree- Agree - Strongly agree \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12. Rate (on a scale of 1−10) the usefulness of telephonic care during the COVID-19 pandemic: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13. Rate (on a scale of 1−10) how confident you felt delivering telephonic care: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2587474.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Questionnaire administered to paediatricians regarding the urgent telephone care service set at the hospital.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Covid-19: a remote assessment in primary care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 7 | 20 |
| 2024 October | 52 | 44 | 96 |
| 2024 September | 70 | 25 | 95 |
| 2024 August | 69 | 59 | 128 |
| 2024 July | 46 | 27 | 73 |
| 2024 June | 50 | 38 | 88 |
| 2024 May | 71 | 40 | 111 |
| 2024 April | 48 | 33 | 81 |
| 2024 March | 47 | 20 | 67 |
| 2024 February | 67 | 27 | 94 |
| 2024 January | 48 | 22 | 70 |
| 2023 December | 28 | 30 | 58 |
| 2023 November | 54 | 39 | 93 |
| 2023 October | 41 | 26 | 67 |
| 2023 September | 41 | 21 | 62 |
| 2023 August | 40 | 16 | 56 |
| 2023 July | 42 | 24 | 66 |
| 2023 June | 36 | 30 | 66 |
| 2023 May | 53 | 30 | 83 |
| 2023 April | 31 | 19 | 50 |
| 2023 March | 30 | 19 | 49 |
| 2023 February | 26 | 16 | 42 |
| 2023 January | 30 | 25 | 55 |
| 2022 December | 47 | 25 | 72 |
| 2022 November | 45 | 22 | 67 |
| 2022 October | 61 | 47 | 108 |
| 2022 September | 45 | 26 | 71 |
| 2022 August | 50 | 36 | 86 |
| 2022 July | 113 | 55 | 168 |
| 2022 June | 45 | 26 | 71 |
| 2022 May | 48 | 37 | 85 |
| 2022 April | 49 | 29 | 78 |
| 2022 March | 53 | 57 | 110 |
| 2022 February | 38 | 34 | 72 |
| 2022 January | 44 | 32 | 76 |
| 2021 December | 33 | 39 | 72 |
| 2021 November | 42 | 42 | 84 |
| 2021 October | 55 | 76 | 131 |
| 2021 September | 26 | 36 | 62 |
| 2021 August | 29 | 42 | 71 |
| 2021 July | 23 | 35 | 58 |
| 2021 June | 50 | 66 | 116 |
| 2021 May | 115 | 53 | 168 |
| 2021 April | 32 | 32 | 64 |
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