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Efficacy of emergency medical center use of a protocol during telephone calls to give medical advice related to fever or gastroenteritis: a cluster randomized controlled trial

Reuter PG, Durand-Zaleski I, Ducros O, Grignon O, Megy-Michoux I, Sourbes A, Desmettre T, Javaud N, Lapostolle F, Vicaut E, Adnet F

AP-HP, Service des Urgences et Service d’Aide Médicale Urgente, Centre Hospitalier Universitaire Avicenne, Bobigny Cedex, France. Université Paris 13, Sorbonne Paris Cité, Bobigny, France. AP-HP, Service d’Aide Médicale Urgente 92, Hôpital Raymond Poincaré, Garches, France. AP-HP Health Economics Research Unit, INSERM UMR 1123, Paris, France. Service de Santé Publique, Hôpital Henri Mondor, AP-HP, Université Paris 12, Créteil, France. SAMU-SMUR 95, Centre Hospitalier René Dubos, Pontoise, France. SAMU 44, PHU Urgences –Médecines – Soins Critiques, Centre Hospitalo-Universitaire de Nantes, Nantes Cedex, France. SAMU SMUR Urgences, Centre Hospitalier Châteauroux, Châteauroux, France. SAMU 82, Centre Hospitalier de Montauban, Montauban, France. Urgences et SAMU 25 – Centre Hospitalier Régional Universitaire de Besançon, , Besançon Cedex, France. Université de Franche Comté-Bourgogne, UMR 6249 CNRS/UFC, Besançon Cedex, France. AP-HP, Urgences, Centre de référence sur les angioedèmes à kinines (CRéAk), Hôpital Louis Mourier, Université Paris 7, Colombes, France. AP-HP, Unité de Recherche Clinique, Saint Louis – Lariboisière – Fernand Widal University Hospital, AP-HP, Paris, France.

Objective. To determine the efficacy of emergency medical center physicians’ use of a protocol to guide their management of telephone consultations for fever and gastroenteritis.
Methods. Cluster randomized controlled trial. Participating centers were randomized to use the telephone protocol or provide usual telephone assistance. Six emergency centers in France included calls from patients needing advice on fever or gastroenteritis. Centers assigned to the protocol followed specific guidelines on managing the call and giving advice on treatment. Primary endpoints were the number of in-person visits and hospital admissions required within 15 days of the call. Secondary endpoints were patient satisfaction and costs.
Results. A total of 2498 calls were included. Use of the assigned protocol while attending 1234 calls was associated with a relative risk for hospitalization or an unscheduled in-person visit for care of 0.70 (95% CI, 0.58–0.85) versus usual practice. Ambulance use, admission to an intensive care unit, mortality, morbidity, and symptom improvement did not differ significantly between centers using the protocol and those following usual practice. Ninety percent of the patients were satisfied. The cost of care was €91 in centers applying the protocol and €150 in the other centers (P < .01).
Conclusions. Use of the protocol was associated with fewer unscheduled in-person visits for care and fewer hospital admissions. The protocol is safe and less costly than the centers’ usual approaches to giving telephone advice.

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