Case study

Dr Ohja minimises Covid-19 infection risk with remote examination

Dr Vinod Ohja
MBBS MS MRCGP
GP
 at 
Mayfield Surgery
 in 
Stoke on Trent
Devices used

Background

Digital consultation has been a topical issue in recent years and mixed views have been expressed regarding its use. The Covid-19 pandemic brought its significance into the limelight and many clinicians are now turning to digital consultations to maintain patient care. Digital consultations allow clinicians to address and identify any acute concerns with their patients without the risk of viral transmission.

The number of patients presenting to general practice has seen a significant drop during the Covid-19 pandemic. Consequently, patients are at risk of having acute conditions left untreated. Digital consultations have opened a new avenue to assess potentially sick patients who may not have presented to the GP in person. NHS England continues to advise against face-to-face consultation, unless absolutely necessary. Whilst safety netting can be useful in certain instances, it cannot be a definitive solution as certain conditions can worsen without any overt symptoms.

Objective assessment of patients may still be required to generate accurate management plans. One such example of a condition requiring consultation is lower urinary tract infection, which is a common condition amongst females and most cases can be easily treated remotely. However, if complications arise by an ascending infection then NICE has published guidelines about the choice of antibiotics and set out admission criteria for patients. Formal assessment is not possible in a ‘’traditional’’ remote consultation without proper examination, as there is an increased risk of missing complications in such patients.

Case presentation

A 26-year-old female presented with fevers and rigors associated with flank pain over a 24-hour period. The patient:

  • complained of increased urinary frequency and dysuria
  • denied nausea, vomiting, changes in bowel habits, dizziness, and lightheadedness
  • had been given a prescription for Nitrofurantoin by her regular GP but was unable to receive it for unknown reasons
  • did not have any significant past medical history and did not take any regular medications

Learning points

  • Clinicians must adapt to the evolving nature of patient consultations as a result of the Covid-19 pandemic.
  • Certain conditions can silently become complicated without the patient realising early on and therefore require objective assessment.
  • Arc allows for an innovative approach to remote patient consultations where initial baseline observations can be objectively measured, and a detailed history can be obtained.
  • Arc can bridge the gap between a face-to-face and remote consultation and help improve patient safety.

Outcome

On inspection, the patient looked unwell and in distress. Using Arc, I found that her heart rate was 111bpm and her temperature taken at the forehead was 38.3C. Her systolic blood pressure was 70, and several repeat measurements in both arms showed that this value was consistently below 90. Her oxygen saturation was 98%. 

Given the digital and remote aspect of the consultations, sepsis from a UTI was swiftly considered as a possibility to ensure the patient could be managed appropriately and safely early on. NICE recommends to refer patients above the age of 16 with pyelonephritis with any three of the following symptoms: 

  • Temperature greater than 38°C or less than 36°C, and
  • Marked signs of illness (such as impaired level of consciousness, perfuse sweating, rigors, pallor, significantly reduced mobility), or
  • Significant tachycardia, hypotension, or breathlessness

As this patient demonstrated four of the symptoms and a history consistent with UTI, she was therefore advised to call an ambulance.

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