A5V4d

Feverish illness in children
Further evidence was presented from NHS Direct that, in line with the out-of-hours Quality
Requirements, currently recommends a time frame of less than 2 hours for a child requiring an urgent
face-to-face assessment. Audit data from NHS Direct was presented to the GDG to show that, of
those who contact NHS Direct via the 0845 telephone number, 31.8% of children under 5 years with a
primary diagnosis of fever were referred on for an urgent face-to-face clinical assessment within
2 hours, following detailed nurse assessment (Figure 11.3). Also, 47% of out-of-hours calls for the
same patient group were referred for a face-to-face clinical assessment within 2 hours. (It is important
to note that during the course of these assessments a focus for the fever may be identified which in
itself justified the referral within this time period.)
One stakeholder comment suggested that a 2 hour time limit for an urgent referral would be very
difficult to implement in an A&E care setting where the 4 hour waiting time directive is the current
target for the NHS. The guideline is clear that primary care should continue to be the first point of
contact for a child with fever (as validated by the NHS Direct data presented here showing that
children with fever are referred to the GP within 2 hours, 6 hours or for a routine appointment). The
GDG clarified that the new recommendation means that a child with ‘red’ features should be offered
an initial assessment (for example, by an A&E triage nurse) within 2 hours, and that the current target
of 4 hours for A&E is the time limit for initial assessment, treatment and discharge. The promise to
patients derived from the NHS Plan in 2000 set out in Your Guide to the NHS stated that, on arrival in
A&E, ‘you should be assessed by a nurse or doctor, depending on how urgent your case is, within
15 minutes of arrival …’. 248
These two waiting time targets are therefore compatible and in keeping with the Department of Health
NHS Plan and Quality Requirements. Other stakeholders who commented on the 2 hour time frame
felt that it was too long a wait for children requiring an urgent referral.
Figure 11.3 NHS Direct audit data covering the period 1 January 2006 to 31 December 2006; this data equates
to a coverage of the whole of the population of England for the 0845 46 47 calls and a population coverage of
708,500 for the out-of-hours calls
The GDG believes that, if the traffic light system is adhered to, the recommendation for a 2 hour
urgent referral will apply to a smaller but more relevant proportion of children with fever than are
currently referred for an urgent assessment. A GDG member who is a GP presented evidence to the
GDG from a survey of children presenting with fever as their predominant symptom and the
prevalence of ‘amber’ features in this patient group. The practice has 9518 patients, with 633 children
aged 5 years and under.
There were 157 consultations in this age group, involving 77 children with 83 episodes of acute fever
with no other symptoms that worried the parent. Fifty-three episodes were telephone triage, and in 24
of these cases a face-to-face consultation was advised (45.2%). In thirteen of these cases, an ‘amber’
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