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

In consultation with the three EDs of MSH and UHN, we adapted the national fever assessment guidelines 6 into a simple decision-algorithm for use in the ER (figure 1), as well as supporting materials for clinicians and patients (see online supplementary files 1 and 2). Patients are eligible for RAFT Clinic referral if they: report subjective fever or are objectively febrile in the ED; have travelled outside North America to a tropical or subtropical destination in the past year; are being assessed in the ED between 08:00 on Sunday to 08:00 on Friday. Exclusion criteria for RAFT Clinic referral include: unstable vital signs; significant laboratory derangements; volume depletion; fulfilment of other standard hospital admission criteria; and initial malaria screening that is positive for P. falciparum malaria. For patients referred to the TDU via the RAFT algorithm, we offer a same-day or next-day assessment clinic (RAFT Clinic), which runs concurrently with regularly scheduled ambulatory tropical medicine clinics. The RAFT Clinic is operational on weekdays, and is staffed by 1-2 administrative assistants, 1 of 2 staff physicians on each day and up to three rotating resident trainees. A roster of eight staff physicians in tropical medicine offer coverage of TDU staff physician absences. No additional hospital resources were committed to development or implementation of the programme. Since the RAFT clinic operates concurrently with regularly scheduled tropical medicine clinics, there is no net increase in resources allocated.