Type of publication:
Conference abstract
Author(s):
*Moumneh R.; McMonnies K.; Johnston V.; Eisen S.
Citation:
Archives of Disease in Childhood. Conference: Royal College of Paediatrics and Child Health Conference, RCPCH 2025. Glasgow United Kingdom. 110(Supplement 1) (pp A123-A124), 2025. Date of Publication: 01 Jun 2025.
Abstract:
Why did you do this work? Multiple viral haemorrhagic fevers (VHFs) are classified as high consequence infections due to high mortality and potential for human-to-human transmission. 1 To aid early identification and prevent outbreaks, our hospital has designed an electronic screening tool to be used at triage in our emergency department (ED) to identify patients presenting with fever within 21days of travel to a VHF endemic country. This study aimed to evaluate if this electronic triage tool was being used appropriately in our Paediatric ED to support early identification and appropriate management of children at risk of VHF. What did you do? A random sample of 50 children (<18 years) presenting to our central London acute hospital with current or recent history of fever (>37.5oC) between March – May 2024 had their electronic health care records reviewed (EPIC ©) to evaluate if the electronic triage tool was being used. A data extract of where the triage tool had been used in EPIC between January – March 2024 was used to identify children at risk of VHF; case notes were then reviewed for evidence of appropriate isolation and escalation. All data were anonymised and analysed using Microsoft ExcelTM. What did you find? The triage tool was used correctly in 32/ 50 febrile children (64%). The triage tool was not used in 6 cases (12%) and used incorrectly (not fully completed or incorrect information included) in 12 cases (24%). 47 children were identified in the triage tool as at risk of VHF (fever within 21days of travel to VHF endemic country). There was no evidence of consideration of VHF, isolation or escalation in any of these cases. What does this mean? Early identification of cases is key to preventing healthcare associated outbreaks, protecting both staff and patients. The current implementation of the VHF triage tool in our Paediatric ED has not been shown to assist with this early identification. The VHF triage tool was frequently not used or incorrectly completed. Even when used, identification of VHF risk did not result in appropriate isolation or escalation of children at risk of VHF. One explanation for this might be the increased number of presentations of 'fever in the returning traveller' in the paediatric population therefore the triage tool is seen as unnecessary additional workload, or the significance of high consequence infections is not considered. Following this study, we developed a paediatric specific quick reference guide for conducting VHF risk assessments and to guide early management of children 'at risk' of VHF. Multidisciplinary departmental teaching has resulted in a positive impact on staff confidence in use of the tool and in responding to identification of VHF risk (evaluation in full write-up). We plan to re-audit the use of the triage tool and subsequent management once established.
DOI: 10.1136/archdischild-2025-rcpch.166
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