Parental Compliance After Telephone Triage Advice During and After Confinement During the COVID-19 Epidemic in France

Novel Coronavirus disease 2019 (COVID-19) outbreak seriously challenges worldwide health care
systems. The current climate of anxiety due to COVID-19 and home confinement limiting access
to emergency departments (ED) have induced an increase of phone calls to the emergency call
center "15" for medical advices.

So far, Lenval Hospital pediatric ED didn't have a standardized telephonic triage protocol
fitted to COVID-19 epidemic. Therefore, a telephonic triage tool is created as a decision
support system in order to help physicians in regulating patient's pathways and in providing
standardized medical advices.

To determine whether a pediatric telephone triage protocol may improve patient's orientation
during COVID outbreak, parental compliance is assessed after telephone advice, during and
after home confinement (the date of end of home confinement in France is 11th May 2020).

From 14th April 2020 to 7th June 2020, all calls received by the platform of telephone calls
at Children's Lenval Hospital during open hours and open days are collected. For each call,
symptoms are recorded by trained physicians and trained residents of the pediatric emergency
department (PED) using a telephonic triage tool through a directed interview. A medical
orientation is recommended to parents at the end of their call. Follow-up are conducted 2 to
4 days after with their consent by telephone interview in order to evaluate their compliance.
Whatever the medical orientation given to parents, the investigators were able to visit PED
in case of worsening of their child's condition or whenever they would feel the need a
physical examination

Questioning parents about clinical condition of their child without a clinical look is
challenging: on the one hand, clinical status of any sick child may change quickly; In the
other hand, parents may not be reliable in evaluating their child's condition according to
their level of concern. COVID-19 outbreak context may exacerbate parental anxiety and
therefore induce inappropriate behavior.

Parents was considered as "non compliant" if they haven't followed the orientation initially
given by the physician after telephone triage. They was considered as "compliant" (1) if they
have respected the recommended orientation or (2) if they have had to bring their child at
pediatric emergencies because of a worsening of his condition in the next 48 hours of the
first call. In this specific case, to determine if the consultation at pediatric ED was
necessary, the investigators recorded all resources utilization used and final orientation
decided after visiting the ED. Thus, worsening of a child condition was defined as
prescription of any diagnostic act and/or on-site therapeutic and/or hospitalization.

This study would allow to evaluate the applicability and the utility of a formalized
telephone triage protocol fitted to COVID-19 epidemic, performed by trained medical staff in
a Children's Hospital. Consequently, the investigators would be able to extend its use after
the COVID outbreak period