Covid-19 hotlines, helplines and call centers: a systematic review of characteristics, challenges and lessons learned.

BACKGROUND: During the Covid-19 pandemic, a number of hotlines/helplines/call centers was implemented to provide remote services and support public health. The objective of this study was to investigate the characteristics, challenges and lessons learned of implementing Covid-19 hotlines/helplines/call centers during the pandemic. METHODS: PubMed, Web of Science, Scopus, the Cochrane Library, IEEE Xplore, and ProQuest databases as well as Google Scholar were searched between 1st January 2020 and 31st December 2023 to retrieve relevant articles published in English. The quality and risk of bias of the studies were assessed using the Appraisal tool for Cross-Sectional Studies (AXIS), the Mixed Methods Appraisal Tool (MMAT), and Critical Appraisal Skills Programme (CASP) Checklist. RESULTS: In total, 43 out of 1440 articles were included in this study. About half of the hotlines/helplines/call centers were launched in March 2020 (n = 19). Providing psychological support (n = 23), reliable information about Covid-19 (n = 10), healthcare advices about Covid-19 (n = 8), and triage (n = 7) were the most common purposes of implementing these services. The most common challenges included a lack of physical examination, unavailability of hotlines/helplines/call centers at the point of need, and delay in updating Covid-19 information. The most common lessons learned were employing qualified staff, providing proper training, and getting feedback from the callers and operators. CONCLUSION: According to the results, most of the Covid-19 hotlines/helplines/call centers were launched in the early months of the pandemic, and about half of them were active seven days a week. Most of the operators were mental health providers and clinicians. The findings show the importance of continuous psychological support during crises, particularly when adequate information about the situation is not available. The challenges experienced by the callers and operators as well as the lessons learned by the service providers also need to be considered for future crises to increase the effectiveness of similar services.

Patient Complaints to the Saudi Medical Call Center: Representative Response Strategies.

This study aims to investigate the strategies and modifications employed by the Complaint Unit Representatives (CURs) in response to complaints recorded in the formal workplace of a medical institution in the Saudi Ministry of Health (MOH). A pragmatic discourse analytic approach was adopted to construct an analytical framework for authentic spoken complaint responses in the Saudi medical institution context. The data were randomly collected from 80 recorded phone conversations between patients and the CURs. It was transcribed verbatim, imported into MAXQDA for qualitative analysis of codes categorizations, and then into SPSS for statistical analysis. The findings showed that the staff employed a balance of transactional and interpersonal approaches in their response strategies, which varied in both quantity and quality depending on the phase or the major sequence of the moves made in the complaint call. Specifically, more transactional strategies were used during the main portion of a complaint and in the medial phase, while more interpersonal strategies were employed during the initial and the final phases of the call. The findings also showed that the CURs tended to downgrade and mitigate their responses to patients' complaints, and they never used upgraders. The influence of the religious culture was also noticeable in their use of downgraders, including optimistic devices and religious expressions. These findings reveal practical implications that can aid the quality team of the Complaint Unit (CU) in assessing the effectiveness and efficiency of the CURs' response strategies when handling complaints, and in providing more effective communication training as needed.

Emergency calls from migrants to an emergency call centre: A retrospective epidemiological study.

OBJECTIVE: The study aims to evaluate migrants' inclination to call emergency call centres. Records of calls made to an emergency call centre by migrants of different age groups and nationalities were reviewed retrospectively. MATERIALS AND METHODS: A total of 4481 emergency call records from migrants of 33 different nationalities was evaluated between 2017 and 2021. RESULTS: Migrants called the emergency call centres mostly for medical reasons, and most of their calls resulted in referrals to hospitals. Pain, fever, nausea, and vomiting were among the most common medical reasons for emergency calls. The majority of the calls were in the green triage category, and the calls spread over the week. CONCLUSION: The results showed that migrants use emergency call services in non-emergency situations. The study recommended enhancing migrants' knowledge of when and how to utilise emergency call centres and making health planning to meet their specific needs.

Prevalence of night eating syndrome among inbound call centre employees in Kuala Lumpur, Malaysia.

Background: Night eating syndrome (NES) is described as a disordered eating pattern relative to sleep, where consumption of food occurs in the evening and night. Numerous studies had been conducted in various populations but studies on (NES) among call centre employees are limited. Aim: This study aimed to determine the prevalence of NES and its determinants among selected inbound call centre employees in Kuala Lumpur, Malaysia. Methods: In this cross-sectional study, a total of 217 inbound call centre employees were recruited through random sampling. A self-administered socio-demographic and work-related questionnaire was used to collect data on the background of the respondents. Information on NES and well-being was obtained by using the Night Eating Questionnaire (NEQ) and World Health Organisation-Five Well-Being Index (WHO-5) respectively. Data on dietary intakes, smoking habits, alcohol intakes and life stress were acquired using a Simple Lifestyle Indicator Questionnaire (SLIQ) while eating behaviour of the respondents was studied using the Three-Factor Eating Questionnaire (TFEQ-18). Results: The mean age of the respondents was 24.1 ± 6.0 years. The prevalence of NES was 12.0% (95% CI = 8.12-17.24). The binary logistic regression identified that NES is significantly associated with adequate exercise (AOR = 4.250, p = 0.012) and emotional eating (AOR = 6.510, p = 0.014). Conclusion: This study showed that the prevalence of NES was high in the call centre and repeated nocturnal eating can have multiple adverse health effects. Therefore, promoting healthy eating habits are crucial to reduce the impacts of NES.

Using an Exposure Call Center to Help Mitigate Outbreaks, Such as COVID-19, on a University Campus.

Rapid identification and management of close contacts is an important component of an effective university mitigation strategy for highly contagious infectious diseases such as measles and coronavirus disease-2019 (COVID-19). Institutions of higher education must plan for an associated large influx of calls that can overwhelm standard student health and local public health operations. In fall 2020, a large state public university's Department of Student Health and Wellness created a dedicated exposure call center (ECC), in close collaboration with the local public health department, to quickly assess students who learned of a COVID-19 exposure outside of the formal contact tracing process. The ECC operated 7 days a week and fielded 3361 calls: 3187 from students and 174 from staff, faculty, and parents. The ECC provided rapid assessment and guidance for students with COVID-19 exposure, allowing for prompt quarantine and medical assessment when warranted. Call centers can increase the bandwidth of university health centers and also reduce the burden on health care providers and other public health resources during periods of crisis or high demand.

[The functioning of call-center in conditions of COVID-19 pandemic].

In conditions of persisting high morbidity of COVID-19, issues related to prompt and timely medical care of population remains actual ones. The purpose of the study to analyze activities of the call-center of the Ministry of Health Care of the Udmurt Republic related to organization of medical care of COVID-19 patients in the Udmurt Republic. MATERIALS AND METHODS: The statistical (descriptive statistics) and descriptive methods were applied. The indicators of functioning of the call-center of the Ministry of Health Care of the Udmurt Republic in 2020-2022 were analyzed. The psychological characteristics of telephone counseling were studied. The satisfaction of medical organizations and citizens with services of call-center operators was assessed. THE RESULTS: The main principles of telephone counseling are confidentiality, maintenance of framework of working conversation, respect to personality of addressee. In 2020 the call center phone line received 34160 calls, in 2021 - 128339 calls, in 2022 - 65618 calls. In 25 months of operation the call-center operators received 228,117 calls from citizens related to issues of new coronavirus infection. The number of patient calls to the hot-line increases significantly when incidence of new coronavirus infection increases (r=0.885; p<0.05). Most frequently (25.1%) citizens contacted the call-center of the Ministry of Health Care of the Udmurt Republic due to inability to reach the polyclinic and on issues related to primary before-doctor care. The second place in terms of frequency (18.5%) took issues related to PCR-test results. The third place (14.1%) took issues related to duration of quarantine for patients and persons residing with them, possibility for children to attend preschool and educational institutions. The number of outgoing calling in 2020 was 16146, in 2021 - 89269 and in 2022 9936 calls. During 25 months of operation, call-center operators made 204,782 calls to citizens to monitor their health status and invite them to vaccinations and health screenings. More than half of outgoing calls (58.3%) were related to audio-monitoring of patients undergoing outpatient treatment with making-up of electronic protocol. CONCLUSIONS: During the period of increasing of COVID-19 morbidity, the call-center becomes an independent structural unit of organizing patient care. The medical organizations and citizens are satisfied with functioning of the call-center of the Ministry of Health Care of the Udmurt Republic organized in order of improving the organization of medical care of patients with COVID-19.

The Unrecognized Role of VA Call Center and Primary Care Clerical Staff in Assisting Patients with Obtaining Needed Care.

BACKGROUND: VA clerks, or medical support assistants (MSAs), are a critical part of patients' primary care (PC) experiences and are often the first points of contact between Veterans and the healthcare system. Despite the important role they might play in assisting Veterans with accessing care, research is lacking on the specific tasks they perform and what training and preparation they receive to perform their roles. OBJECTIVE: Our primary aim in this study was to document MSA perceptions of their roles, the tasks they undertake helping Veterans with accessing healthcare, and additional training they may need to optimally perform their role. DESIGN: Thematic analysis of semi-structured qualitative interviews with VA call center and PC MSAs (n=29) collected as part of in-person site visits from August to October 2019. PARTICIPANTS: MSAs at administrative call centers and primary care clinics in one large VA regional network representing 8 healthcare systems serving nearly 1.5 million Veterans. KEY RESULTS: We identified three key findings from the interviews: (1) MSAs perform tasks in addition to scheduling that help Veterans obtain needed care; (2) MSAs may not be fully prepared for their roles as first points of contact; and (3) low status and lack of recognition of the important and complex tasks performed by MSAs contribute to high turnover. CONCLUSIONS: As healthcare systems continue expanding virtual access, the roles of administrative call center and PC MSAs as first points of contact will be increasingly important for shaping patient experiences. Our research suggests that MSAs may need better training and preparation for the roles they perform assisting Veterans with accessing care, coupled with an intentional approach by healthcare systems to address MSAs' concerns about recognition/compensation. Future research should explore the potential for enhanced MSA customer service training to improve the Veteran patient experience.

Medical imaging call centre: a communication success story.

AIM: To evaluate utilisation of a medical imaging call centre (MICC) at a multi-site, academic radiology department, focusing on communication of critical, urgent, or significant unexpected findings. MATERIALS AND METHODS: Institutional research ethics board approval was obtained. All calls made to MICC from 1 January to 31 December 2019 were reviewed retrospectively. The total number of calls, date, and reason of each call, level of report alert, and turnaround time (TAT) were recorded. Level 1, 2, and 3 alerts were defined as "potentially life-threatening new/unexpected findings", "could result in morbidity/mortality", or "not immediately life-threatening or urgent", respectively. TAT was defined as the time from alert request received by the MICC until acknowledgement of receipt by the referring physician, with a desired TAT of 60 min, 3 h, and 3 days for each level, respectively. RESULTS: The MICC received 29,799 calls in 2019, on average 2,483 (range 1,989-3,098) calls per month. The most common indications for contacting the MICC were to request imaging reports to be expedited (14,916 calls, 50%) and issuing report alerts to communicate unexpected or urgent findings (7,060 calls, 24%). Average number and range of calls for Level 1, 2, and 3 alerts were 57 (39-80), 345 (307-388), and 187 (127-215) per month, respectively. Average TAT for Level 1, 2, and 3 report alerts were 59 min, 2 h 26 min, and 19 h 39 min, respectively. CONCLUSION: The MICC received a large volume of calls and was a successful method for timely communication of unexpected or urgent imaging findings using a three-tiered alert system.

Performance evaluation of an EMS system using queuing theory and location analysis: A case study.

In emergency medical services (EMS), response time is a key factor that shows the performance of the system. This factor is composed of two parts including activation time and travel time. The activation time of an emergency call is the time a call center spends on taking an incoming call for EMS and decides whether an ambulance should be dispatched or the emergency can be resolved by giving some medical advices. Having a good number of call center operators including call takers and dispatchers can help to reduce this time and thus the response time. However, this alone may not be enough to have a reasonable cycle time. In fact, having idle ambulances located in right places when emergency calls occur is an influential factor to reduce the travel time and thus have an optimal response time and save people's lives. Although many researchers have studied improving either the activation time or the travel time, to the best of our knowledge, there exists no study focusing on both. Motivated by this gap, in this study, a framework is proposed which uses queuing theory and location analysis to address both activation and travel times. In this regard, first, queuing theory is applied to evaluate the performance of an EMS call center and reduce the average activation time. Then, three mathematical models including mobile stations, MEXCLP and MECRP are applied to locate ambulances such that the average travel time is minimized. To shed light on the merits of using queuing theory and location models, computational results based on the real-world data from Tehran EMS Center are provided. The proposed methodology can reduce the average response time by approximately four minutes and increase the average coverage by 35%. This work is an example of the tremendous positive impact that the application of queuing theory and mathematical modeling can have. The proposed framework can significantly decrease the cycle time and increase the ambulance coverage level. The findings of this study help the policy makers of EMS centers with evaluating the performance of their systems and determining the optimal number of operators and locations of ambulances in a way that enhances the quality of emergency services.

Hundred Days of Teleconsultations and Their Usefulness in the Management of COVID-19: Experience of the COVID-19 National Call Center in Bolivia.

Background: There is currently little scientific evidence on the usefulness of implementing strategies against COVID-19 remotely with the help of telemedicine. Objective: Evaluate whether teleconsultation is helpful as an instrument of mediated care in the monitoring and follow-up of individuals with high suspicion of COVID-19 through early detection by the Call Center COVID-19 of the Ministry of Health and Sports, Bolivia. Methodology: Descriptive and cross-sectional observational study of patients captured by the Call Center-COVID-19, who were monitored and followed up in their homes through teleconsultations carried out by the National TeleHealth Program, remotely through information and communication technologies throughout the Bolivian territory during the first 100 days of its implementation. Results: A total of 3,278 patients were studied, recruited between March 16 and June 23, 2020; 49.4% were women, with an overall mean age of 37.5 years (standard deviation [SD] 15.2). The mean detection time was 7.6 days (SD 6.92); 93.8% required home isolation, and only 6.2% were transferred for hospitalization. The mean follow-up time for all patients was 6.7 days (SD 4.87; range 2-38). A total of 75.6% were discharged as recovered patients, and 1.9% died. Conclusions: Early detection of individuals with suspected COVID-19 was achieved, knowing their clinical evolution until their recovery or death. Teleconsultations showed good outcomes at discharge and low fatal outcomes. From these results, it can be inferred that teleconsultation is a valuable tool in the monitoring, evaluation, and follow-up of patients. The Ministry of Health and Sports through Call Center-COVID-19 reinforced the Epidemiological Surveillance System as a passive search tool for possible suspected cases at the national level and decongesting other services in charge of this task.

[Evaluation of a clinical orientation Call Center during the first months of the COVID-19 pandemic]. / Evaluación de un call center de orientación clínica durante los primeros meses de pandemia COVID-19: capacidad de resolución de los llamados.

BACKGROUND: During sanitary emergencies such as the recent pandemic, health services can collapse. In these cases, remote orientation services such as call centers may help to debottleneck these services. AIM: To assess the demand and problem resolution of a clinical guidance telephone service during the COVID-19 pandemic. MATERIAL AND METHODS: The call registry between May and August 2020 of an orientation call center for COVID-19 was analyzed. The number of calls, sociodemographic features of callers, type of enquiry and given indications were described. RESULTS: We analyzed 1,278 telephone calls, corresponding to 655 people. Sixty nine percent of queries were resolved during the call and in 31% of calls, users were referred to face-to-face evaluation. Two percent of these referrals were to an emergency service. CONCLUSIONS: The call center had a high level of resolution, favoring remote consultation and reducing face-to-face care, improving users'accessibility.

[Involuntary Psychiatric Hospitalizations: From request to a call center to hospitalization]. / Admission en soins psychiatriques a la demande d'un tiers : de l'appel au SAMU a l'hospitalisation.

BACKGROUND: Involuntary psychiatric hospitalization (IPH) is a heavy and complex psychiatric exception measure. In the Seine-Saint-Denis department (low medical density), the evaluation of the patient in psychiatric decompensation is the responsibility of the out-of-hours general practitioners (GP) mandated by the call center. Their feeling is the non-achievement of the procedure once the patient arrives at the emergency room. We aimed to evaluate the outcome of patients following a request for IPH from these GP. METHODS: We conducted a retrospective study based on all requests for IPH received during 2016 at the Seine-Saint-Denis emergency medical call center. The characteristics of the call and the patient, as well as the decisions of the regulator and the GP were collected. The decision of hospitalization in the emergency room was sought for patients referred for IPH. RESULTS: Of the 7541 calls for decompensation, 539 were for an IPH. These calls occurred during non-working hours in 55 % of cases. A GP was involved in more than two-thirds of the cases and requested an IPH for 240/304 (79 %) patients. Patients were male in 56 % of cases with an average age of 40 (±16) years. IPH was confirmed for 132 (61 %) patients. This rate did not differ from the 65 % reported in the literature (Z-test, P=0.26). Voluntary hospitalization was performed for 37 (17 %) other patients. DISCUSSION: The IPH rate for patients referred by GP mandated by the call center was comparable to that following the requests of the attending physicians, validating their intervention in this critical context.

Occupational diseases among call center operators needing vocal rehabilitation.

BACKGROUND: Work related diseases (WRDs) and occupational diseases (ODs) greatly affect call center operators (CCOs) who experience demanding work expectations and adverse working conditions in their workplace. The aim of this study was to evaluate the sociodemographic and job characteristics of CCOs diagnosed with OD, and to describe the changes in employment status after diagnosis. METHODS: This descriptive study is based on the electronic data records of Istanbul Occupational Diseases Hospital available from February 2007 to March 2018. RESULTS: According to the health board reports, 122 of the 173 (70.5%) CCOs had a confirmed OD diagnosis, 85.2% were females and the mean age was 27.5 years. Vocal cord disorders were the most frequent ODs (64.8%), followed by hearing loss (12.5%), dysphonia (10.2%) and temporomandibular disorders (4.7%). Vocal cord nodules (VCN) were found to be more frequent among females compared to males (92.9% vs 62.4%, p<0.001). Although not statistically significant, the frequency of VCN was also higher in subjects working overtime (14.6% vs 6.3%), having gastroesophageal reflux disease (82.3% vs 73.9%) or thyroid nodules (100% vs 73.7%) and being current smokers (41.7% vs 13.3%). Following the OD diagnosis, 43.8% of the cases were dismissed, 18.7% quit their job, and 9.4% still held the same job position. Only 28.1% changed unit within the workplace. CONCLUSION: Including the CCOs who were diagnosed with an OD at a very young age and at an early stage of their working life into vocational rehabilitation programs and employing them under appropriate conditions is essential to proper health and safety protocol.

Call Center Remote Triage by Nurse Practitioners Was Associated With Fewer Subsequent Face-to-Face Healthcare Visits.

BACKGROUND: In 2015, the Veterans Health Administration (VHA) incorporated nurse practitioners (NPs) into remote triage call centers to supplement registered nurse (RN)-handled calls. OBJECTIVE: To assess 7-day healthcare use following telephone triage by NPs compared to RNs. We hypothesized that NP clinical decision ability may reduce follow-up healthcare. DESIGN: Retrospective observational comparative effectiveness study of clinical and administrative databases. NP routed calls were matched to RN calls based on chief complaint with propensity score matching and multivariate count data models, adjusting for differences in call severity and patient comorbidity. PARTICIPANTS: Callers to a VHA regional call center, April 2015 to March 2019. MAIN MEASURES: Primary care, specialty care, and emergency department (ED) visits plus hospitalizations within 7 days. KEY RESULTS: NP-handled calls (N = 1554) were matched to RN calls (N = 48,024) for the same chief complaint. NP-handled calls, compared to RNs, had lower comorbidities, fewer hospitalizations, and less urgent complaints. Seven-day healthcare use was lower for NP compared to RN calls for specialty care (0.15 vs. 0.20 visits per person [VPP]; p < 0.001), ED (0.11 vs. 0.27 VPP; p < 0.001), and hospitalizations (0.01 vs. 0.04 VPP; p < 0.001), but not primary care (0.43 vs. 0.42 VPP; p = 0.80). In adjusted analyses, estimated avoided in-person visits per 100 calls routed to NPs were 0.7 primary care visits (95% confidence interval [CI] 0.4, 1.0), 2.6 specialty care visits (95% CI 0.0, 5.1), 5.9 ED visits (95% CI 2.7, 9.1), and 1.4 hospital stays (95% CI 0.1, 2.6). Propensity score-matched models comparing NP (N = 1533) to RN (N = 2646) calls had adjusted odds ratios for 7-day healthcare use of 0.75 (primary care), 0.75 (specialty care), and 0.73 (ED) (all p < 0.003). CONCLUSION: Incorporating NPs into a call center was associated with lower in-person healthcare use in the subsequent 7 days compared to routine RN-triaged calls.

Implementation of a referral and expert advice call Center for Maternal and Newborn Care in the resource constrained health system context of the Greater Accra region of Ghana.

BACKGROUND: Referral and clinical decision-making support are important for reducing delays in reaching and receiving appropriate and quality care. This paper presents analysis of the use of a pilot referral and decision making support call center for mothers and newborns in the Greater Accra region of Ghana, and challenges encountered in implementing such an intervention. METHODS: We analyzed longitudinal time series data from routine records of the call center over the first 33 months of its operation in Excel. RESULTS: During the first seventeen months of operation, the Information Communication Technology (ICT) platform was provided by the private telecommunication network MTN. The focus of the referral system was on maternal and newborn care. In this first phase, a total of 372 calls were handled by the center. 93% of the calls were requests for referral assistance (87% obstetric and 6% neonatal). The most frequent clinical reasons for maternal referral were prolonged labor (25%), hypertensive diseases in pregnancy (17%) and post-partum hemorrhage (7%). Birth asphyxia (58%) was the most common reason for neonatal referral. Inadequate bed space in referral facilities resulted in only 81% of referrals securing beds. The national ambulance service was able to handle only 61% of the requests for assistance with transportation because of its resource challenges. Resources could only be mobilized for the recurrent cost of running the center for 12 h (8.00 pm - 8.00 am) daily. During the second phase of the intervention we switched the use of the ICT platform to a free government platform operated by the National Security. In the next sixteen-month period when the focus was expanded to include all clinical cases, 390 calls were received with 51% being for medical emergency referrals and 30% for obstetrics and gynaecology emergencies. Request for bed space was honoured in 69% of cases. CONCLUSIONS: The call center is a potentially useful and viable M-Health intervention to support referral and clinical decision making in the LMIC context of this study. However, health systems challenges such inadequacy of human resources, unavailability of referral beds, poor health infrastructure, lack of recurrent financing and emergency transportation need to be addressed for optimal functioning.

Long term impact of the WHI studies on information-seeking and decision-making in menopause symptoms management: a longitudinal analysis of questions to a medicines call centre.

BACKGROUND: While women are taking a greater role in decisions about menopause symptom management, the legacy of the Women's Health Initiative (WHI) studies persist. Despite hormone therapy (HT) being effective in reducing all-cause mortality, many women seeking relief of menopausal symptoms exaggerate HT harms and overstate the perceived benefits or ignore the risks of alternative therapies. We aimed to explore the longitudinal impact of the widely-publicised WHI 2002 study on women's information-seeking and describe determinants of decision-making about managing menopausal symptoms. METHODS: In a longitudinal analysis of both quantitative and qualitative data, we explored consumer questions about menopause-related medicines received by two Australian medicines call centres (1996-2010) before, during, and after WHI 2002. We analysed calls by age and gender of caller and patient, their relationship, postcode, enquiry type, and motivation to help-seek. We compared calls regarding HT and herbal medicines (HM) with the rest of calls, and thematically analysed question narratives across the three time-periods. RESULTS: There were 1,829 menopause-related calls received of over this time-period, with a call surge, primarily from women in their mid-fifties, in the two months after the WHI 2002 publication. Two in three calls were motivated by negative media reports as women sought support for decision-making, primarily reassurance to cease HT. While HT safety concerns persisted for eight years post-publication, the nature of information-seeking changed over time. Callers subsequently sought reassurance to use menopause treatments together with their other medicines; and pursued HT substitutes, including HM, in response to HT product discontinuation. CONCLUSIONS: Women sought information or reassurance to support a decision, based on dynamic changes in internal (symptom or risk intolerance, attitude towards menopause and treatment preferences) and external factors (perceived source trust and changes in treatment availability). In assessing HT benefit versus risk, women tend to overestimate risk with HT safety concerns persisting over time. Decision-making in managing menopause symptoms is complex and dynamic. Reassurance to reach or justify decisions from a perceived trusted source can support informed decision-making.

A Multimodal Approach to Improve Performance Evaluation of Call Center Agent.

The paper proposes three modeling techniques to improve the performance evaluation of the call center agent. The first technique is speech processing supported by an attention layer for the agent's recorded calls. The speech comprises 65 features for the ultimate determination of the context of the call using the Open-Smile toolkit. The second technique uses the Max Weights Similarity (MWS) approach instead of the Softmax function in the attention layer to improve the classification accuracy. MWS function replaces the Softmax function for fine-tuning the output of the attention layer for processing text. It is formed by determining the similarity in the distance of input weights of the attention layer to the weights of the max vectors. The third technique combines the agent's recorded call speech with the corresponding transcribed text for binary classification. The speech modeling and text modeling are based on combinations of the Convolutional Neural Networks (CNNs) and Bi-directional Long-Short Term Memory (BiLSTMs). In this paper, the classification results for each model (text versus speech) are proposed and compared with the multimodal approach's results. The multimodal classification provided an improvement of (0.22%) compared with acoustic model and (1.7%) compared with text model.

Epidemiology of emergency calls for time-dependent acute illnesses during COVID-19 outbreak in Umbria region (Italy).

The recent literature reported an inverse correlation between COVID-19 pandemic and hospital admissions for Acute Coronary Syndromes (ACS).

[Emergency call center in the era of choosing wisely: when to dispatch an ambulance ?] / Centrale 144 à l'ère du choosing wisely : quand envoyer une ambulance ?

There is a growing demand for prehospital ambulance transport. These urgent transports however seem to be largely misused and are accompanied by risks. Several strategies have been studied with the aim of reducing demand on an already under pressure system. Sending alternative non-medical transport, a mobile nurse team or deciding not to transport a patient are some of these strategies that allow a reduction for urgent transport for non-critical patients. These various approaches bring benefits but still lack evidence regarding safety.

La demande de transport en ambulance est croissante. Ces moyens de transport semblent toutefois largement surutilisés et peuvent générer des risques lorsqu'ils circulent en urgence. Plusieurs stratégies ont été étudiées afin de diminuer la demande sur un système déjà sous pression. L'envoi d'un transport alternatif non médicalisé, d'une équipe infirmière mobile ou la décision de non-transport d'un patient représentent certaines de ces stratégies permettant de diminuer l'utilisation d'ambulances pour les patients non critiques. Ces différentes approches apportent des bénéfices mais les preuves quant à l'absence de risque pour les patients sont encore limitées.

Coronavirus Disease Outbreak in Call Center, South Korea.

We describe the epidemiology of a coronavirus disease (COVID-19) outbreak in a call center in South Korea. We obtained information on demographic characteristics by using standardized epidemiologic investigation forms. We performed descriptive analyses and reported the results as frequencies and proportions for categoric variables. Of 1,143 persons who were tested for COVID-19, a total of 97 (8.5%, 95% CI 7.0%-10.3%) had confirmed cases. Of these, 94 were working in an 11th-floor call center with 216 employees, translating to an attack rate of 43.5% (95% CI 36.9%-50.4%). The household secondary attack rate among symptomatic case-patients was 16.2% (95% CI 11.6%- 22.0%). Of the 97 persons with confirmed COVID-19, only 4 (1.9%) remained asymptomatic within 14 days of quarantine, and none of their household contacts acquired secondary infections. Extensive contact tracing, testing all contacts, and early quarantine blocked further transmission and might be effective for containing rapid outbreaks in crowded work settings.