Pediatric telephone advice in the emergency department : results of a mock scenario

To assess the appropriateness of pediatric telephone advice given by emergency departments (EDs), a mock scenario simulating a 5-week-old with fever of 102 degrees F and signs compatible with meningitis was used to evaluate the responses of 61 randomly selected EDs, of which half were affiliated with pediatric residency training programs. All EDs were given the identical chief complaint: "My baby has been having a fever all day, and I can't seem to get it down." Calls were made by research technicians and monitored by one or more of the investigators by speakerphone. Fifty-three (87%) programs gave advice by telephone; in 42 (79%) of the 53 respondents the individual giving advice was a nurse. Fourteen programs (26%) gave advice without asking either the age of the child or height of the fever. Few of the respondents took historical information assessing irritability (4 programs), fluid intake (11 programs), urine output (8 programs), or breathing pattern (6 programs). Thirty-eight (71.7%) EDs advised the patient to see a physician, while only 32 (60.4%) suggested same-day evaluation. In several instances the caller was not advised to seek medical attention despite having given a history documenting the infant's fever, irritability, and lethargy. These findings show variability and inadequacies in pediatric telephone advice currently offered by the EDs that were studied.