Evaluation of a programme for ‘Rapid Assessment of Febrile Travelers’ (RAFT): a clinic-based quality improvement initiative

Jazuli, Farah; Lynd, Terence; Mah, Jordan; Klowak, Michael; Jechel, Dale; Klowak, Stefanie; Ovens, Howard; Sabbah, Sam; Boggild, Andrea K

Mean time to RAFT Clinic assessment following ED discharge was 1.2±0.07 days (range 0-4 days) Figure 1 Algorithm for assessment of fever in the returned traveller. †The Rapid Tropical Assessment Clinic is designed to ensure definitive disposition of a febrile returned traveller within 24 hours of their initial emergency room presentation. Between Friday after 8:00 and Sunday before 8:00, as well as statutory holidays and the obligatory ambulatory closure for 2 weeks over the Christmas/New Year's block, the Rapid Tropical Assessment Clinic is unavailable. During these times, if the patient does not have Plasmodium falciparum or otherwise fulfil admission criteria, the patient should still be referred to General Internal Medicine or Infectious Diseases for disposition (as per standard historical procedure). §Additional investigations should be based on clinical judgement. For example, a febrile returned traveller with diarrhoea should also have stool investigations; a febrile returned traveller with dysuria should have urine Culture&Sensitivity±STI screening, etc.*If the malaria screen is positive for Plasmodium vivax, P. ovale or P. malariae (ie, non-P. falciparum), please initiate chloroquine therapy: 4 tablet loading dose (600 mg base), followed by 2 tablets 6 hours later. Completion of therapy will be organised by the Rapid Tropical Assessment Clinic. If the malaria screen is positive for P. vivax and the patient travelled to Papua New Guinea or Indonesia, please initiate Malarone therapy: 4 tablets orally×1 with food. Completion of therapy will be organised by the Rapid Tropical Assessment Clinic. Chloroquine tablet: 150 mg base (in a 250 mg tablet). Treatment course: Loading dose of 600 mg base, followed by 300 mg base 6 hours later. This is followed by 300 mg base at 24 and 48 hours for a total of 1.5 g base. Malarone tablet: fixed combination of 400-mg atovaquone+100-mg proguanil. Treatment course: 4 tablets orally once daily with food ×3 days. CBC, complete blood count; ICU, intensive care unit; ID, infectious diseases; LFT, liver function test; NP, nasopharyngeal; P. falciparum, Plasmodium falciparum; STI, sexually transmitted infections.