Effect of an Intervention Combining the Use of Standardized Information and Sending an SMS Advice Message to Parents Calling the SAMU Center 15 for Uncomplicated Fever in Children

Effect of an Intervention Combining the Use of Standardized Information and Sending an SMS Advice Message to Parents Calling the SAMU Center 15 for Uncomplicated Fever in Children Over 3 Months and Under 10 Years of Age : a Regional Cluster Randomized Trial

During the winter of 2022/23, a standardized protocol for managing fever in children aged 3 months to 10 years was implemented at Annecy Genevois Hospital for a period of one month. This protocol included advice given by the regulator and sending a text message to parents after the call. A total of 182 calls were handled in one month: 95 during a 15-day period before the intervention was rolled out and 87 during a 15-day period during the intervention (43 with unread text messages and 44 with read text messages). All parents who read the text message understood it. The rate of compliance with advice was improved by the intervention when the text message was read (p < 0.01), in terms of increased paracetamol intake, avoidance of cold baths, undressing the child, and administering fluids. When the text message was read, the rate of calls to the 15 emergency center fell from 13% before the intervention to 2% when the text message was read (p = 0.04). A downward trend in emergency room visits was also observed, from 13% before the intervention to 5% when the text message was read and 19% when the text message was not read (p = 0.13). These encouraging data suggest that a randomized study would demonstrate the value of this approach in routine practice.

Even if the effect of such protocols is moderate, the target audience is such that their impact on the use of unscheduled care and on the healthcare system could be significant, at a low implementation cost.

The use of a standardized protocol involving the sending of text messages in cases of uncomplicated fever in children makes it possible to:

• standardize the advice given by call center doctors,
• ensure the traceability of advice,
• help parents monitor their children.

The objective of this study is to determine, in a randomized trial, whether the combined use of standardized advice for children with fever and text messages sent to parents by the emergency medical service (EMS) can:

i) reduce the use of unscheduled medical care; ii) improve compliance with advice; iii) reduce the rate of callbacks to the emergency medical service; iv) improve parent satisfaction.

Inclusion criteria relating to the child concerned by the call to the SAMU Centre 15:

• Call for a child aged between 3 months and 10 years,

• Presenting with fever alone (SFMU/GPIP definition),

• Developing for less than 72 hours,

• Without clinical signs,

• And without signs of seriousness requiring emergency medical attention (as determined by SAMU Centre 15):

  • Fever ≥41°C,
  • Impaired consciousness,
  • Convulsions,
  • Dyspnea,
  • Skin rash,
  • Dehydration.

Inclusion criteria relating to the caller:

• Caller with parental authority over the child concerned by the call,
• Affiliated to a social security scheme or beneficiary of a similar scheme.

Exclusion criteria relating to children involved in calls to the SAMU Centre 15 emergency medical service:

• Children who have already been the subject of a call to the SAMU Centre 15 emergency medical service in the last 15 days,
• Children with a history of urinary tract infection,
• Children referred by the dispatcher during the phone call to a healthcare facility for clinical evaluation (SMUR, private ambulance, fire department, parents referred to the emergency room or primary care physician).

Exclusion criteria relating to the caller:

• Calls made from a landline or foreign number, making it impossible to send text messages,
• Calls made by someone who cannot read or understand French.