Video triage of children with respiratory symptoms at a medical helpline is safe and feasible–a prospective quality improvement study

Caroline Gren; Asbjoern Boerch Hasselager; Gitte Linderoth; Marianne Sjølin Frederiksen; Fredrik Folke; Annette Kjær Ersbøll; Hejdi Gamst-Jensen; Dina Cortes

doi:10.1371/journal.pone.0284557

Peer Review History

Original SubmissionMarch 24, 2021
26 Apr 2021 Decision Letter - Richard Bruce Mink, Editor PONE-D-21-06235 Video triage of children with respiratory symptoms at a medical helpline is safe and feasible – a prospective quality improvement study PLOS ONE Dear Dr. Gren, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The authors report interesting data regarding the use of video triage of children with respiratory illness; however, the information provided about parental satisfaction is better served by including it in the companion paper that was submitted.I suggest reworking this paper so that it focuses strictly on the patient outcomes. Also, please refrain from indicating that a measure "increased" or "decreased" when, in fact, there is no statistical difference. The wording implies that there was a change but if the measures do not achieve statistical significance, this is is not so. Please submit your revised manuscript by Jun 10 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Richard Bruce Mink Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please provide additional details regarding participant consent. 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As per the PLOS ONE policy (http://journals.plos.org/plosone/s/submission-guidelines#loc-human-subjects-research) on papers that include identifying, or potentially identifying, information, the individual(s) or parent(s)/guardian(s) must be informed of the terms of the PLOS open-access (CC-BY) license and provide specific permission for publication of these details under the terms of this license. Please download the Consent Form for Publication in a PLOS Journal (http://journals.plos.org/plosone/s/file?id=8ce6/plos-consent-form-english.pdf). The signed consent form should not be submitted with the manuscript, but should be securely filed in the individual's case notes. Please amend the methods section and ethics statement of the manuscript to explicitly state that the patient/participant has provided consent for publication: “The individual in this manuscript has given written informed consent (as outlined in PLOS consent form) to publish these case details”. If you are unable to obtain consent from the subject of the photograph, you will need to remove the figure and any other textual identifying information or case descriptions for this individual. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0284557.r001
Revision 1
30 Jun 2021 Author Response Dear Richard Bruce Mink On behalf of all the authors, I thank you for your interest in our manuscript ”Video triage of children with respiratory symptoms at a medical helpline is safe and feasible – a prospective quality improvement study” (PONE-D-21-06235). We are today submitting a revised version, changed according to your points raised. Thus, we have moved all data regarding user satisfaction to the accompanying paper (“We can’t do without it”: parent and call-handler perceptions on video triage of children at a medical helpline, PONE-D-21-08760), and this present paper now solely focuses on patient outcome. We have also changed wordings such as decreased and increased when the statistical tests do not support it. The additional requirements, such as style requirements and consent forms for clinical pictures have also been fulfilled. We would like to underline the fact that, as mentioned in the manuscript, sharing of sensitive patient data originating from quality improvement data is prohibited in the Danish legislation, but an anonymized minimal data set has been prepared and can be requested by addressing the contact person mentioned in the manuscript. We sincerely hope that this revised manuscript is accepted for publication, as we believe that it makes an important contribution to the knowledge of using video streaming in health services, a tool getting steadily increased focus worldwide. Kind regards, Dr. Caroline Gren Attachments Attachment Submitted filename: response to reviewers.docx https://doi.org/10.1371/journal.pone.0284557.r002
9 May 2022 Decision Letter - Wubet Alebachew Bayih, Editor PONE-D-21-06235R1Video triage of children with respiratory symptoms at a medical helpline is safe and feasible – a prospective quality improvement studyPLOS ONE Dear Dr. Gren, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jun 23 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Wubet Alebachew Bayih, M.Sc. Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you for the opportunity to review this manuscript. I was not a reviewer for the initial submission but have read both versions. This is a great study concept and design. Congratulations on this very important work. See specific minor edits below. Line number references are from the revised document with Track Changes. One primary concern I have is with the use of the word “feasible” – in that nearly 10%, or 70 of the 734 calls included, either declined video triage or were unsuccessful in video streaming (data is from Figure 1). My concern is that those who declined may have done so due to lack of smartphone (line 132) or other device, or reliable internet to achieve this. Either way, it appears that video is not feasible for ~10% of the population sampled. This should be commented on in the discussion. Additionally, for the ones triaged to video, can you please comment on how many were started as video and then could not be successfully completed? This is partially addressed in Figure 1, but could be improved. I do recommend that you write about this relevant detail from this figure in the manuscript narrative, and not only refer to the Figure. Please provide brief details about the intervention beyond “the technology is described in detail elsewhere” – it would serve the readers to have a brief summary, even if one sentence, for clarity in this manuscript. Patient outcome (line 242): in this section, it is not clear to the reader whether within 8 hours the patients assessed in the hospital were because of the recommendation of the triaging call/video. Please be more clear about proportion of patients who were triaged to each outcome versus those who were triaged to one outcome but then presented to the hospital anyway - because of clinical condition or other; this needs to be fleshed out in the discussion as well, and would be beneficial in the paragraph starting at line 333 The results presented do not support that added assertion that video is “acceptable” (conclusion, line 432), given that parent and provider perspectives are removed from this paper. Otherwise, I do recommend an additional review for grammar and syntax. For instance, make sure that sentences that start with numbers have them spelled out (e.g. line 235 “There 63% of … “ should read “Sixty-three percent of…” and delete the “There”). Another example is the parenthetical reference to a different paper that you have submitted (line 85 and line 163, “reference to accompanying paper”). There are other grammatical errors throughout the manuscript, please review and correct. I very much look forward to your revisions and to seeing this published! ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0284557.r003
Revision 2
18 Jun 2022 Author Response Please see the attached "response to reviwers" document, where all comments have been responded to. Attachments Attachment Submitted filename: response to reviwers 180622.docx https://doi.org/10.1371/journal.pone.0284557.r004
24 Nov 2022 Decision Letter - Wubet Alebachew Bayih, Editor PONE-D-21-06235R2Video triage of children with respiratory symptoms at a medical helpline is safe and feasible – a prospective quality improvement studyPLOS ONE Dear Dr. Gren, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== ACADEMIC EDITOR:The authors should give informative description of how the measurement of their findings was done. I mean you should explain your methodology both in the abstract and methods section of the manuscript. ============================== Please submit your revised manuscript by Jan 08 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Wubet Alebachew Bayih, M.Sc. Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: (No Response) ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: (No Response) ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: Thank you for inviting me to review this manuscript entitled on: Video triage of children with respiratory symptoms at a medical helpline is safe and feasible – a prospective quality improvement study The study aimed at to study the safety and feasibility of introducing video triage of young children with respiratory symptoms at a medical call center, as well as the impact on patient outcome. The authors have raised very important issue. After the authors address the following concerns, it will be suitable for publication to Plose one journal Questions and comments The abstract is somehow complex to understand. It would be better if authors make it clear. It lacks some points which must be included in the method section of the abstract. It doesn’t sate clearly about the data collection tools, study period, final sample size, study design and model of data analysis Why children’s less than six months are excluded from the study? Explain how the limitation of this study affect your result. How the authors did model testing? if no justify, if yes state clearly. How is the validity of the data collection tool? was it validated? if yes reference, if no justify ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0284557.r005
Revision 3
19 Dec 2022 Author Response -Thank you for inviting me to review this manuscript entitled on: Video triage of children with respiratory symptoms at a medical helpline is safe and feasible – a prospective quality improvement study. The study aimed at to study the safety and feasibility of introducing video triage of young children with respiratory symptoms at a medical call center, as well as the impact on patient outcome. The authors have raised very important issue. After the authors address the following concerns, it will be suitable for publication to Plose one journal -We thank you for your time and effort in reviewing our manuscript, and we hope that you will find our comments and corrections satisfying. We too find this an important issue that deserves attention. -The abstract is somehow complex to understand. It would be better if authors make it clear. It lacks some points which must be included in the method section of the abstract. It doesn’t sate clearly about the data collection tools, study period, final sample size, study design and model of data analysis -We have now added the wanted information (data collection tools, study period, sample size and data analysis) to the abstract. Final sample size: 617; study design: prospective quality improvement study with patients enrolled to video or standard telephone triage (1:1); data analysis: “Logistic regression was used to test the effect on outcomes.” (this is the main method used); and finally, study period (February 2019-March 2020) has been added to abstract and results section, thank you for pointing this out. -Why children’s less than six months are excluded from the study? -Yes, this is a relevant question, thank you. We chose 6 months as a cut-off due to infants relatively more often having severe illness, and we therefore did not want to take any chances in this early phase, before we were sure that video triage was safe. Also, infants are inherently harder to assess than older children, and are generally recommended to be assessed face-to-face. We have added a section about this at lines 123-126. -Explain how the limitation of this study affect your result. -Yes, this is a very relevant discussion. The most important limitation, that the study was not conducted as a randomized controlled study, due to the call-handlers not having time to inform the patients sufficiently for a written informed consent, and difficulties of setting the computers up to do the randomization, conveys the possibility that the two groups (video and telephone triage groups) are not completely alike. But as age, gender, symptoms and hospital outcome are similar, we reckon that the groups are comparable. But of course, a randomized controlled trial would have been preferable. Another important limitation is that we did not reach the calculated sample size, due to the Corona pandemic. Had we reached the sample size calculated beforehand, we believe that we would have reached a significant result concerning how many patients that were assessed at hospital after the call. Lastly, we cannot know how video triage works in patients in other ages or with other symptoms, this must be tested in other studies, and that would be interesting to investigate. However, we tested video triage in the most frequently occurring pediatric population at this medical helpline, i.e. young children with symptoms from the airways, so the results should thus be representative for a large part of pediatric calls. This discussion can be found in the limitations-section as well. -How the authors did model testing? if no justify, if yes state clearly -We tested the model during the first two weeks of the study, the pilot phase, where we evaluated how the nurses experienced the set-up and how the technical solution worked. Afterwards we made some smaller adjustments. Also, before this study was launched, a study at the Danish emergency helpline was using the same technical set-up (GoodSAM instant-on-scene) and we therefore could use some the experiences gained from that study. -How is the validity of the data collection tool? was it validated? if yes reference, if no justify -We are not completely certain what is understood by “data collection tool” in this context. However, the surveys answered by the call-handlers were not validated more than by oral feedback from the call-handlers during the pilot period regarding for example clarity of wording. Concerning the internal electronic patient records at MH1813, they are used every day and maintained by a data management department, and data concerning all the participating children was found and was complete. Data collection from the hospitals’ electronic charts were done manually by the first author, and all children were identified, and all wanted data was able to be obtained. Generally, Danish registers are renowned to be complete and reliable. Attachments Attachment Submitted filename: response to reviewers 191222.docx https://doi.org/10.1371/journal.pone.0284557.r006
4 Apr 2023 Decision Letter - Wubet Alebachew Bayih, Editor Video triage of children with respiratory symptoms at a medical helpline is safe and feasible – a prospective quality improvement study PONE-D-21-06235R3 Dear Dr. Gren, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Wubet Alebachew Bayih, M.Sc. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: All my concerns were fully addressed . Thank you very much for your commitment and motivation . You have raised an important issue . ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #2: No ******** https://doi.org/10.1371/journal.pone.0284557.r007
Formally Accepted
10 Apr 2023 Acceptance Letter - Wubet Alebachew Bayih, Editor PONE-D-21-06235R3 Video triage of children with respiratory symptoms at a medical helpline is safe and feasible – a prospective quality improvement study Dear Dr. Gren: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Wubet Alebachew Bayih Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0284557.r008

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