Fever in the Returning Traveller Triage Assessment

NB: If a patient has already been discussed with ID pre hospital and sent to the ED we can assume they don't present an HCID risk. 

Has the patient been identified at reception as having recently (< 21 days) returned from a high risk country?

If No: go to: Fever in Returning Traveller Guidance from RIDU

If Yes:

Step 1: Protect ourselves from risk of infection 

Avoid contact.

Maintain your distance where possible.

Minimise time in patient room.

Use Airborne PPE (see below) if contact required. 

Step 2: Immediate actions

• Ensure patient is in the ECG room with access to a phone and is wearing a surgical mask.
• No entry sign on ECG room doors.
• Contact Nurse in Charge and discuss with senior doctor (ST3+).
• Relatives should be asked to leave unless unwell, in which case they too will need to be segregated from the waiting room.
• No observations required as standard
• The patient should not go into resus unless requested by EM consultant. 
• Consider early redirection to patient's own car at consultant discretion - to contact NHS 24.

Step 3: Gather more information over the telephone

Follow triage travel history guidance below:

• Where did you go?
  
  • It is essential to know the countries (and locations within these) visited/transited and the exact dates of travel.
• What did you do there?
  • Were they working with animals? What animals? Any consumption of 'bush meat'/animals products
• When did you become unwell?
  • Did they have contact with anyone else who was unwell? How were they unwell? When?
• Brief history of symptoms:
  • cough, coryza, flu like illness, myalgia.
• Do they have a history of feverishness? We don't need a recorded temperature at this stage.

HCID (High Consequence Infectious Disease) risk assessment:

Has the patient developed a fever and respiratory illness within 14 days of travel or transit in the Middle East?If yes, consider MERS. 

Has the patient had a history of fever within 21 days of travel to Africa? If yes consider VHF

A complete list of HCIDs are listed on the UKHSA guidance page, along with this country-specific risk list. 

Step 4: If patient contact is not avoidable - appropriate initial PPE is:

PPE doffing, remove PPE into a bin IMMEDIATELY on leaving the ECG room in the order below:

1. Remove gloves - do not touch the outside front of the gloves, they will be contaminated.
2. Clean hands and wrists (and forearms if necessary) with alcohol-based hand rub or gel
3. Remove gown - do not touch the outside front of the apron, this will be contaminated.
4. Clean hands and wrists again with alcohol-based hand rub or gel, or use soap and water.
5. Carefully remove visor from the back and discard away from you into bin
6. Clean hands and wrists again with alcohol-based hand rub or gel, or use soap and water.
7. Remove mask - do not touch the front of the mask but remove by the ear loops or ties.
8. Clean hands and wrists again with alcohol-based hand rub or gel, or use soap and water.

Patient waste should be quarantined with the patient until the patient is no longer consider a possible HCID.

Follow ID guidance for management of samples and waste.

Step 5: Next Steps

All patients who are a concern for a potential HCID should be discussed with the ID physician on-call immediately. If uncertain, ID are happy to support risk assessment.

The patient should be isolated in the ECG room and further contact avoided until after this discussion.

Do not perform observations, tests or examinations until after discussion with ID. 

Possible HCID:

Management on case by case basis. Some patients may be transferred to RIDU. Patients who are kept in the Emergency Department to await testing to exclude HCID should be moved to the isolation bay in the Surgical Observation Unit as this is the only area with appropriate ventilation. This area will already have patients in it and will require support from site and capacity to move the patient to down stream wards. 

HCID Unlikely:

If not a concern for HCID the patient can be brought into triage and follow Fever in Returning Traveller Guidance from RIDU