Fever in children under 5 years of age: how safe is home teleconsultation
DOI:
https://doi.org/10.15574/SP.2023.129.51Keywords:
home teleconsultation, telemedical sorting, children, feverAbstract
The use of home teleconsultation in outpatient pediatric practice has become widespread in many countries over the world, regardless of their economic situation. Each country has its own experience in the practical implementation of home teleconsultation in medical care for patients, but the issue of increasing its effectiveness remains topical.
Purpose - to consider the issue of improving the efficiency and safety of home teleconsultation for children under 5 years old with fever.
Materials and methods. The terms «home teleconsultation», «telemedicine sorting», «children», «fever» were searched using Pub Med Central databases. The data of the regulatory and legal protocols in Ukraine were taken into account while determining the recommendations.
Results. Research in recent years proves that new forms of communication between a doctor and a patient, his parents or guardians create both additional opportunities and risks regarding various aspects of the quality of medical care. According to the data of literary sources, conclusions were made that the quality of home teleconsultation for children under 5 years of age is affected by: social and ethical features of communication with children and their parents; lack of standards/scenarios for telephone consultation for a specific pathology; lack of appropriate professional training of doctors. The article provides measures to improve home teleconsultation: the use of telesorting scenarios (NICE protocol/standard for children under 5 years with fever) using a «traffic light system», alarm symptoms («red flags») to predict the risk of serious illness and taking into account the availability of the use of the «safety net». There is a well-founded need for professional training of medical workers in the field of telemedical consultation.
Conclusions. The implementation of home teleconsultation services in outpatient pediatric practice in situations where a child’s condition is assessed by a medical professional who cannot examine him because the child is geographically distant will contribute to a faster setting of priorities for the provision of primary medical care. In today’s environment, the NICE (2021) protocol/standard for the assessment and initial treatment of fever in children under 5 years of age is a clinical scenario that meets the requirements for home teleconsultation. The introduction of the leading international experience of organizing home teleconsultation for children under 5 years of age is the basis for improving programs of continuous professional experience of medical workers who provide assistance to children.
No conflict of interests was declared by the authors.
References
Almond S, Mant D, Thompson M. (2009). Diagnostic safety-netting. Br J Gen Pract. 59 (568): 872-874. https://doi.org/10.3399/bjgp09X472971; PMid:19861036 PMCid:PMC2765844
Biondi E, Evans R, Mischler M, Bendel-Stenzel M, Horstmann S, Lee V, Aldag J, Gigliotti F. (2013, Dec). Epidemiology of bacteremia in febrile infants in the United States. Pediatrics. 132 (6): 990-996. https://doi.org/10.1542/peds.2013-1759; PMid:24218461
Bohomaz VM, Barzylovych AD. (2020). Samootsinka likariamy dosvidu dystantsiinoho konsultuvannia patsiientiv. Ukrainskyi medychnyi chasopys. 5 (139): 8-11. https://doi.org/10.32471/umj.1680-3051.139.187521
Chiappini E, Vitale A, Badolato R, Becherucci P, Careddu D, Di Mauro A, Doria M, Staiano A. (2022, Apr 26). The Effective Management of Fever in Pediatrics and Insights on Remote Management: Experts' Consensus Using a Delphi Approach. Front Pediatr. 10: 834673. https://doi.org/10.3389/fped.2022.834673; PMid:35558379 PMCid:PMC9087841
Christ M, Grossmann F, Winter D, Bingisser R, Platz E. (2010, Dec). Modern triage in the emergency department. Dtsch Arztebl Int. 107 (50): 892-898. https://doi.org/10.3238/arztebl.2010.0892; PMid:21246025 PMCid:PMC3021905
Christ M, Grossmann F, Winter D, Bingisser R, Platz E. (2010, Dec). Modern triage in the emergency department. Dtsch Arztebl Int. 107 (50): 892-898. https://doi.org/10.3238/arztebl.2010.0892; PMid:21246025 PMCid:PMC3021905
Dadlez NM, Adelman J, Bundy DG, Singh H, Applebaum JR, Rinke ML. (2020, May 12). Contributing Factors for Pediatric Ambulatory Diagnostic Process Errors: Project RedDE. Pediatr Qual Saf. 5 (3): e299. https://doi.org/10.1097/pq9.0000000000000299; PMid:32656467 PMCid:PMC7297397
Dieckmann RA, Brownstein D, Gausche-Hill M. (2010, Apr). The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatr Emerg Care. 26 (4): 312-315. https://doi.org/10.1097/PEC.0b013e3181d6db37; PMid:20386420
Fernandez A, Benito J, Mintegi S. (2017, Nov-Dec). Is this child sick? Usefulness of the Pediatric Assessment Triangle in emergency settings. J Pediatr (Rio J). 93 (1): 60-67. https://doi.org/10.1016/j.jped.2017.07.002; PMid:28846853
Fiks AG, Kelly MK, Nwokeji U, Ramachandran J, Ray KN, Gozal D. (2022, Aug 6). A Pediatric Telemedicine Research Agenda: Another Important Task for Pediatric Chairs. J Pediatr. S0022-3476(22)00681-3. https://doi.org/10.1016/j.jpeds.2022.07.048; PMid:35944724 PMCid:PMC9439872
Gomez B, Mintegi S, Bressan S, Da Dalt L, Gervaix A, Lacroix L, European Group for Validation of the Step-by-Step Approach. (2016, Aug). Validation of the «Step-by-Step» Approach in the Management of Young Febrile Infants. Pediatrics. 138 (2): e20154381. https://doi.org/10.1542/peds.2015-4381; PMid:27382134
Gomide AC, Silva RM, Capanema FD, Gonçalves LA, Rocha RL. (2014). Como os pais lidam com a febre infantil: influência das crenças, conhecimento e fontes informação no cuidado e manejo da febre na criança - revisão sistemática da literatura. Rev Med Minas Gerais. 24 (2): 175-180.
Haimi M, Brammli-Greenberg S, Baron-Epel O, Waisman Y. (2020, Apr 3). Assessing patient safety in a pediatric telemedicine setting: a multi-methods study. BMC Med Inform Decis Mak. 20 (1): 63. https://doi.org/10.1186/s12911-020-1074-7; PMid:32245469 PMCid:PMC7126468
Haynes S, Marcin J. (2022, Apr). Pediatric Telemedicine: Lessons Learned During the Coronavirus Disease 2019 Pandemic and Opportunities for Growth Advances in Pediatrics. PMCID: PMC8979775.
Haynes SC, Kamerman-Kretzmer R, Khan SS, Crossen S, Lieng MK, Marcin JP et al. (2022, Jan). Telemedicine use for pediatric asthma care: a mixed methods study. J Asthma. 3: 1-10. https://doi.org/10.1080/02770903.2021.2019265; PMid:34913803
Lakshin G, Banek S, Keese D, Rolle U, Schmedding A. (2021, Mar). Telemedicine in the pediatric surgery in Germany during the COVID-19 pandemic. Pediatr Surg Int. 37 (3): 389-395. https://doi.org/10.1007/s00383-020-04822-w; PMid:33388961 PMCid:PMC7778404
Mavropulo TK, Mokiia-Serbina SO. (2022). Telefonni konsultatsii pediatrychnykh patsiientiv - naskilky tse bezpechno? Zdorovia dytyny. 3 (11): 39-50. https://doi.org/10.22141/2224-0551.17.3.2022.1511
Ministerstvo okhorony zdorovia Ukrainy. (2019). Rezultaty opytuvannia likariv pervynnoi lanky u piaty oblastiakh. URL: https://moz.gov.ua/uploads/2/14077-telemedicina_2019_05_27_ukr.pdf.
Ministerstvo okhorony zdorovia Ukrainy. (2022). Polozhennia pro kabinet telemedytsyny zakladu okhorony zdorovia. Nakaz Ministerstva okhorony zdorovia Ukrainy 19.10.2015 No. 681. Iz zminamy, vnesenymy zghidno z Nakazom Ministerstva okhorony zdorovia No. 218 vid 03.02.2022. URL: https://zakon.rada.gov.ua/laws/show/r1400-15#Text.
Mintegi S, Bressan S, Gomez B, Da Dalt L, Blázquez D, Olaciregui I et al. (2014, Oct). Accuracy of a sequential approach to identify young febrile infants at low risk for invasive bacterial infection. Emerg Med J. 31 (e1): e19-24. https://doi.org/10.1136/emermed-2013-202449; PMid:23851127
NICE. (2021). Fever in under 5s: assessment and initial management NICE guideline [NG143]. Published: 07 November 2019. Last updated: 26 November 2021. NICE guideline published. URL: https://www.nice.org.uk/guidance/ng143. https://doi.org/10.1136/archdischild-2021-321718; PMid:34244233
Nigrovic LE, Mahajan PV, Blumberg SM, Browne LR, Linakis JG, Ruddy RM et al. (2017, Jul). The Yale Observation Scale Score and the Risk of Serious Bacterial Infections in Febrile Infants. Pediatrics. 140 (1): e20170695. https://doi.org/10.1542/peds.2017-0695; PMid:28759413 PMCid:PMC5495524
Oldroyd C, Day A. (2011, Jul). The use of pediatric early warning scores in the emergency department. J Emerg Nurs. 37 (4): 374-376; quiz 424. https://doi.org/10.1016/j.jen.2011.03.007; PMid:21600639
Puls reference. (2020). Clinical support tool for remote clinical assessment. Fever pathway 2020. URL: https://www.pulsetoday.co.uk/covid-19-primary-care-resources/guides/11-primary-care-pathways-for-remotely-assessing-children/.
Rademacher NJ, Cole G, Psoter KJ, Kelen G, Fan JWZ, Gordon D, Razzak J. (2019, May 8). Use of Telemedicine to Screen Patients in the Emergency Department: Matched Cohort Study Evaluating Efficiency and Patient Safety of Telemedicine. JMIR Med Inform. 7 (2): e11233. https://doi.org/10.2196/11233; PMid:31066698 PMCid:PMC6530260
Rees P, Edwards A, Powell C, Hibbert P, Williams H, Makeham M et al. (2017, Jan 17). Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis. PLoS Med. 14 (1): e1002217. https://doi.org/10.1371/journal.pmed.1002217; PMid:28095408 PMCid:PMC5240916
Severini RDSG, Oliveira PC, Couto TB, Simon Junior H, Andrade APM, Nanbu DY, Farhat SCL, Schvartsman C. (2022, Mar-Apr). Fast, cheap and feasible: Implementation of pediatric telemedicine in a public hospital during the Covid-19 pandemic. J Pediatr (Rio J). 98 (2): 183-189. https://doi.org/10.1016/j.jped.2021.05.007; PMid:34181889 PMCid:PMC8196314
Simon Junior H, Pedreira MC, Barbosa SMM, Fernandes TF, Escobar AMU. (2022, Aug 8). Clinical management of fever in children in Brazil: practical recommendations from an expert panel. Einstein (Sao Paulo). 20: eRW6045. https://doi.org/10.31744/einstein_journal/2022RW6045; PMid:35946741 PMCid:PMC9345508
Telemed24. (2020). Poriadok orhanizatsii medychnoi dopomohy na pervynnomu, vtorynnomu, tretynnomu rivniakh iz zastosuvanniam temedytsyny (internet-resurs). URL: https://telemed24.ua/articles/poryadok-organizacii-meddopomogy-iz-zastosuvannyam-telemedycyny.
Waisman Y. (2016). Telemedicine in pediatric emergency care: an overview and description of a novel Service in Israel. J Intensive & Crit Care. 2: 2. doi: 10.21767/2471-8505.100026.
https://doi.org/10.21767/2471-8505.100026
WHO. (1997). A health telematics policy in support of WHO's Health-for-all strategy for global health development: report of the WHO Group Consultation on Health Telematics. URL: https://apps.who.int./iris/handll/10665/63857.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Modern pediatrics. Ukraine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
