Case study

Dr Sultana saves time by diagnosing respiratory tract infections remotely

Dr Kishwar Sultana
MBChB MRCGP MRCOG
GP
 at 
Kelvin Medical Centre
 in 
Glasgow
Devices used

Background

Cough and fever are some of the most common presentations in primary care. These symptoms are commonly caused by a virus, especially when associated with other symptoms e.g. coryza. In some circumstances, it can be caused by a bacterial infection, which may require antibiotics. Clinical predictors such as the CURB-65 score help to determine the severity and where community treatment is appropriate, but they rely on examination findings.

Case presentation

A 50-year-old female patient presented with a relapse of symptoms of a chesty cough and fever, following recent treatment for a chest infection. The patient:

  • was otherwise fit and well
  • had no comorbidities or allergies
  • was a non-smoker

Learning points

  • With the use of Arc diagnostic equipment, had the oxygen levels been low or her heart rate high, then referral to A&E would have been arranged. 
  • Without the availability of the diagnostic equipment, the patient would have needed to attend a face-to-face consultation for a physical examination to obtain observations and chest auscultation findings. This would require further time and practical considerations of attaining a GP appointment, which may not have been possible on the day. This could lead to a delay in treatment and possible decline overnight. 
  • Alternatively, she may have needed to attend A&E for physical assessment, which may result in a long inconvenient wait for the patient. 
  • Attending her GP or A&E would mean taking up further resources in terms of clinician time and capacity.

Outcome

General examination of the patient showed that she was alert, coherent and not visibly breathless or using accessory muscles. This visual impression was supplemented with the use of diagnostic equipment available for the patient to use while maintaining social distancing. She was found to have a moderate fever of 38.2C. Blood pressure, heart rate and oxygen saturations were measured and within the normal range. A chest examination was conducted and revealed left lower basal crackles.

A diagnosis of lower respiratory infection was confirmed. The CURB-65 score was low risk. Treatment with antibiotics in the community was given appropriately.

The patient did not have to attend for further assessment, face-to-face examination with her GP or to attend A&E. Patient safety advice was given to attend if there were signs of worsening condition or recurrence of infection.

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