A5V4d

6 Management by remote
assessment
Introduction
When a concerned parent or carer decides to make contact with a healthcare professional about a
feverish child, the initial contact may be by telephone and in these circumstances a remote
assessment may be undertaken. In this context, ‘remote’ refers to the assessment of the child’s
symptoms carried out by an assessor who is geographically remote from the child. It is common
practice for remote assessment to be carried out during the out-of-hours period and, similarly, remote
assessment may be a prerequisite for patients requesting an urgent in-hours appointment with their
GP. Specific advice lines also exist, such as the 0845 4647 service offered by NHS Direct. * 999 calls
to the ambulance service are similarly assessed in order to determine the urgency of the response
required.
The purpose of the remote assessment is to identify the level of care the child needs and to refer to
the most appropriate location of care to meet those needs within an appropriate time frame. This
process will include the identification of those with potentially life-threatening compromise to airway,
breathing, circulation and level of consciousness, those with symptoms suggestive of serious illness
and also identification of those children who are most likely to have a self-limiting illness and for whom
care at home is the most appropriate option.
The skills and experience of the healthcare professional carrying out the remote assessment will vary
and their assessment may or may not be supported by decision support software or other paperbased
protocols. Remote assessment can be difficult as the assessor has only the symptoms
reported by the caller on which to base the assessment. An additional difficulty, particularly when
assessing a small child, is that the quality of information reported by the caller is likely to be variable
and may be influenced by parental/carer concern. Symptoms which concern one parent/carer may not
concern another and similarly symptoms which concern a parent/carer may not be those which most
concern a healthcare professional.
It is essential that listening and critical thinking skills are employed throughout the assessment in
order to ensure that all cues are identified and interpreted appropriately. This will include taking into
account the level of parental/carer concern, the cause of which may not be easy to pinpoint. At times,
however, it will be possible to identify a likely cause of the fever and that being the case the
appropriate guidance for that condition should be followed.
In some circumstances the child may not be geographically remote from the assessor but physical
examination of the child may not fall within the scope of practice for that healthcare professional. The
assessor may thus feel it is more appropriate to follow the remote assessment guidance rather than
that for face-to-face assessment which takes into account signs found on physical examination.
6.1 Clinical assessment
It is assumed that children with feverish illnesses undergoing a remote assessment will have a clinical
assessment as described in Chapter 5. By necessity, the emphasis will be on detecting symptoms
rather than physical signs. The first priority is to identify any immediately life-threatening features,
including compromise of the airway, breathing, circulation and level of consciousness. Children with
feverish illness should then be assessed for the presence or absence of symptoms that predict the
* Please note that this service will be replaced by NHS 111, which is due to be implemented nationally in 2013.
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