Risk Stratification Tools

In this step, we will consider ways in which we can support diagnosis and treatment decisions made during remote consultations, with validated ‘risk stratification’ tools.

Be careful not to get these confused with the assessment of risk in a remote consultation that we covered during week 1. In the context that we are discussing here, such tools are utilised in a clinical context to guide a potential diagnosis and/or treatment. Patients are typically assigned a score based on a number of questions and/or clinical signs and assigned a risk of low, medium or high.

Scoring patients in this way allows us to:

• Manage our patients’ more proactively.
• Make better use of limited resources.

Documenting scores as part of the healthcare record can also be a useful objective clinical ‘feature’ to track over time.

Please bear in mind that the tools we refer you to in this section are often recommended for use by the National Institute for Health and Care Excellence (NICE) in the UK. We recommend that you check if the same tools or similar ones are recommended wherever you are, by the appropriate governing bodies.

We’ve already mentioned one risk stratification tool when we were considering escalation of unwell patients, the NEWS2 score. Whilst this may have a limited scope for application in remote settings (due to lack of equipment in patients’ homes, for example pulse oximeters or blood pressure monitors) there are a host of other risk stratification tools that you might want to use.

Head over to the ‘desktop consultation dashboard’ at the website below and see if you recognise any of the ‘clinical tools’ listed?

https://www.bradfordvts.co.uk/new-trainee/desktop-consultation-dashboard

Now pick one or two of these tools and use the discussion board to explain why you think they might be useful when used in a remote setting.

You might like to use the following prompts to structure your answer:

1. Does the tool require a face to face consultation?
2. Does the tool require use of equipment?
3. Is there evidence to suggest that the tool is inaccurate in a remote setting?
4. Is the tool useful in special patient groups or can it be used in all patients?

When you have posted your thoughts, read at least two posts from others to see what tools they have identified and comment on the usefulness of these tools for your setting.

While you are completing this activity, you may want to create a list of the tools that you are most likely to use during remote consultations.