Title:
[Evaluation of a new telephone counseling protocol used by the admission nurse of a pediatric emergency department].

Abstract:
Telephone counseling is a daily occurrence in the pediatric emergency department (ED). It is difficult and has no legal framework. In 2010, we created a new protocol aimed at improving the telephone counseling given by the admission nurse at our pediatric emergency department: an index card is created for every call, color-coded according to severity with a list of clinical items, allowing for simple and reproducible advice.
The aim of this study was to evaluate the reliability of the cards. We conducted a prospective analysis, from June 2011 to January 2012, to analyze every card generated for seven major reasons for calling. The study was designed to: (a) measure the level of accurate completion of the cards by the admission nurse; (b) evaluate the quality of the advice given, as defined by the color coding.
Of 3297 calls received, 1033 cards were included in the analysis: 504 (49%) of these cards were correctly completed for optimal traceability (complete administrative and clinical data, correct color coding). The level of completion significantly increased for admission nurses who had filled in more than ten cards. Among these 504 calls, 386 cards (77%) delivered appropriate advice and 87 (17%) inappropriate advice. Thirty-one cards (6%) could not be evaluated for the quality of the advice given. There was no significant difference between the different causes for calling. Overall, only ten calls (less than 2%) resulted in underestimation of the severity of the child's condition, and 9% in overestimation (leading to an unnecessary consultation in the ED).
The quality of card completion needs to improve, especially since this study demonstrates how easy it is to use these cards. They ensure exhaustive questioning; guide the admission nurse toward safer advice, with appropriate advice given in 77% of cases. The rate of underestimated severity is low, and the initial severity of these cases is debatable because half of these cases consulted at the ED 12-24h after the initial call.
These innovative color-coded cards make it possible to dispense reliable and harmonized advice. They ease the process of an otherwise difficult exercise.