There can be enormous power in the smallest acts. Every nurse knows this, but sometimes we get so focused on our day-to-day routines, we miss opportunities to affect positive change that are directly in front of us. No matter what our setting or area of clinical expertise, just about all providers encounter patients with post-travel illness these days—whether they realize it or not. As you know, in these situations, timing can be critical and outcomes catastrophic, as in the instance of an unidentified case of Plasmodium falciparum malaria or an improperly treated animal bite.
Here are four, simple steps anyone can take to improve outcomes for these patients—and you can start today.
- Identify the Stakeholders –Many of us struggle in our own organizations with limited funds and resources. Remembering to look outside our own departments can be extremely valuable. Who are the key groups in your network that might care about this issue, be advocates for travel patients, and help you identify resources? Does your institution have a Risk Management Department; if so, could you collaborate with it? Risk management teams often have funds and staff to help address these concerns. If you’re in a university setting, could you reach out to parent/students/faculty groups who share the same concerns? Simply raising awareness with these groups can help colleges and universities realize that changes are needed. Corporations also have Risk Management specialists that can help your Employee Health Service unit address this issue- and explain how company insurance may apply.
Thankfully, after the recent Ebola debacle, more hospitals and emergency rooms are trying to improve outcomes for post-travel patients. These hospitals and ERs can be a rich source of ideas for your own setting. Don’t hesitate to contact your local infectious disease departments either. They are usually more than willing to share their expertise with you and your staff to recognize the “do not miss” conditions, and what to do about them.
Reach out to local travel clinics and find out if they provide post-travel services. Sharing challenges and ideas can foster better patient management. Finally, by all means, seek help from your local health departments—after all, their purpose is keeping communities safe, and they can often share many important resources of which you may be unaware.
- Train Non-medical Staff – The person at your setting who takes the first call from a post-travel patient is a critical member of your team. Always include them in training to ensure they immediately bring these patients to the attention of medical staff.
Plenty of quick, unconventional ways exist to do this. Having a 10-minute conversation with your receptionist about how to ask patients about travel, and why it’s important, can be enormously useful. Offer to give a lunch presentation to staff on “The Top Ten Tips for International Travel.” You can create something useful and relevant for your co-workers that will ultimately benefit patients as well—“a win, win,” to be sure.
- Ask Every Patient about Travel and Fever – This should be the standard of care for all team members at your site – no matter what their role. If there is any inkling of history of fever (including subjective history), it is critical to ask about travel. One thing to suggest is to simply include the question, “Have you travelled outside the United States in the last three months?” on the patient encounter form. Ideally, this should be done before the patient comes to the clinic. If you offer online appointment scheduling, this question can be added to your online form as well. Otherwise, make certain clerical staff members are aware of this concern with any patient calling for an appointment.
Don’t forget about signs. Putting one up on your front door such as, “Have you traveled recently? ” can be quite helpful. During the Ebola outbreak, clinics used signs such as, “Have you traveled to Sierra Leone, Liberia, or Guinea? Please call this number before coming inside – to help protect other patients and staff.
- Get a Plan in Place– Even if your facility does not provide post-travel care, you still need to have a plan in place to refer patients appropriately. Know who your actual contacts are in your local health departments, and never hesitate to call them. Learn about useful CDC contacts, such as the malaria hotline, as well as local post-rabies exposure resources. Develop a list of ID specialists you can call for an emergency, same-day appointments and/or consultation. Don’t just give your post-travel patient a referral and send them out the door. Coordinate with your ED or specialist to make sure any referrals do not fall through the cracks. Always notify the ED in advance about any post-travel patient you are referring there.
Be sure to locate reliable laboratory sources for post-travel services. A lab that only functions until 5pm will not meet all your post-travel referral needs. Certain critical lab tests such as malaria smears must be processed the same day.
Yes, these do require some effort on your part, but none of these require you to spend large amounts of money, receive additional training, or commit a huge amount of time. They just require a little initiative—something that, throughout history, nurses have never lacked.
Julie Richards, President
American Travel Health Nurses Association