Visual summary Covid-19: remote consultations Version 1.

3
25 Mar 2020
A quick guide to assessing patients by video or voice call
This graphic, intended for use in a primary care setting, is based on Clinical
data available in March 2020, much of which is from hospital characteristics
settings in China. It will be revised as more relevant data emerges.
Based on 1099
hospitalised patients
1 Set up Have current ‘stay Video is useful for Scan medical record for risk factors such as: in Wuhan, China
at home’ covid-19 Severe illness Diabetes Pregnancy Smoking
Prepare yourself and guidance on hand
decide how to Anxious patients Chronic kidney or liver disease COPD 69% Cough
connect UK government advice: Comorbidities Steroids or other immunosuppressants
http://bit.ly/ukgovisol 22%
Temperature
Hard of hearing Cardiovascular disease Asthma 37.5-38°C

22%
Temperature
>38°C
2 Connect Check video Confirm the Check where Note patient’s phone number
and audio patient’s patient is in case connection fails 38% Fatigue
Make video link if
identity
possible, otherwise Can you Where
call on the phone hear/see Name are you
If possible, ensure the 34% Sputum
me? right now?
Date of birth patient has privacy
19%
Shortness
of breath

3 Get started Rapid assessment Establish what the patient wants 15% Muscle aches
If they sound or look very sick, out of the consultation, such as:
Quickly assess
such as too breathless to talk, Clinical assessment Referral Certificate
whether sick go direct to key clinical questions 14% Sore throat
or less sick Reassurance Advice on self isolation
14% Headache

4 History Contacts Most common presentation 12% Chills

Adapt questions to Close contact with Cough Fatigue Fever Short of breath
patient’s own medical known covid-19 case Nasal
History of Cough is Up to 50% of 5% congestion
history Immediate family
member unwell current illness usually dry but patients do not
sputum is not have fever at Nausea
Occupational Date of first 5%
or vomiting
risk group symptoms uncommon presentation
4% Diarrhoea

5 Examination 24% Any

Over phone, ask carer Over video, Check respiratory function - inability to talk comorbidity
Assess physical and or patient to describe: look for: in full sentences is common in severe illness
mental function as State of breathing General How Is it worse What does
best as you can Colour of face demeanour is your today than your breathlessness Red flags
breathing? yesterday? prevent you doing?
and lips Skin colour
Covid-19:
Patient may be able to take Temperature Pulse Interpret self monitoring results Severe shortness
their own measurements if of breath at rest
Peak flow Blood pressure with caution and in the context
they have instruments at home of your wider assessment Difficulty breathing
Oxygen saturation
Pain or pressure
in the chest
Cold, clammy,
6 Decision and action Likely covid-19 but Likely covid-19, Relevant
Unwell or pale and
well, with mild and needs mottled skin
Advise and arrange follow-up, unwell, deteriorating comorbidities
symptoms admission
taking account of local capacity New confusion
Becoming difficult
Which pneumonia patients Arrange follow up by Proactive, Ambulance to rouse
Self management:
to send to hospital? video. Monitor closely if whole protocol
fluids, paracetamol Blue lips or face
you suspect pneumonia patient care (999)
Clinical concern, such as:
Little or no
• Temperature > 38°C urine output
• Respiratory rate > 20* Coughing up blood
Reduce spread of Safety netting
• Heart rate > 100†
with new confusion virus - follow current If living alone, Maintain fluid Seek immediate Other conditions,
• Oxygen saturation government ‘stay at someone to intake - 6 to 8 medical help for such as:
≤ 94%‡ home’ advice check on them glasses per day red flag symptoms Neck stiffness
Non-blanching rash
* Breaths per minute † Beats per minute ‡ If oximetry available for self monitoring
© 2020 BMJ Publishing Group Ltd.
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