Telehealth assessment and remote examination of children — formative SAQs

SAQ 1 — Febrile toddler video triage (10 marks)

A 2-year-old is booked for urgent video review with fever and reduced intake. The family is at home. You have not yet confirmed their address. [1] [15]

Questions

1. List the pre-clinical safety checks you complete before deep history, and explain why location matters. (3 marks) [7] [15]
2. Describe a remote first impression and caregiver-assisted examination sequence for this child, including what you must document as not examined. (4 marks) [7] [8]
3. The child looks well enough for home care. Outline teach-back and specific safety-net content. (3 marks) [10] [11]

Model answer

Pre-clinical checks (3). Confirm identity, parental responsibility, physical address/location, call-back number, emergency contacts, privacy of the space, and interpreter need. Location matters because mid-visit deterioration requires EMS dispatch to the correct place while you keep the family online. [7] [15]

Remote exam (4). Doorway view: appearance/interaction, work of breathing, colour. History of fever timeline, intake, wet nappies, rash, breathing, vaccines, caregiver concern. Coach RR count, chest wall view, rash mapping, hydration behaviour. Do not claim full auscultation, reliable otoscopy or complete abdominal exam if not achieved. Document limits and confidence. Uncertain ear views are not antibiotic indications by default. [3] [7] [8]

Teach-back and safety-net (3). Explain working impression and plan; ask caregiver to restate. Red flags: harder breathing, fewer wet nappies, non-rousable, non-blanching rash, persistent vomiting, caregiver still worried. State when and how to re-access care, including overnight routes. [10] [11]

SAQ 2 — Rural tele-emergency and stewardship (10 marks)

A rural ED seeks paediatric advice about a toxic child, and separately a DTC-style ear-pain video requests antibiotics on a poor image. [3] [5]

Questions

1. Why prefer video over telephone for the rural ED consult when available? (3 marks) [5] [6] [13]
2. How do you manage the ear-pain request without false certainty? (3 marks) [3] [4] [8]
3. Name three programme-level design features that improve paediatric telehealth quality beyond camera resolution. (4 marks) [1] [2] [14]

Model answer

Video vs telephone (3). Video shows work of breathing, colour and interaction that audio misses; supports transfer and treatment decisions; related trials and quality comparisons favour video-enabled pathways for sick children and can reduce certain prescribing-error risks versus telephone alone. [5] [6] [13]

Ear-pain stewardship (3). State image inadequacy; do not invent otoscopy findings; avoid automatic antibiotics; arrange in-person exam if needed; explain symptomatic care and follow-up; note higher antibiotic pressure in DTC-type pathways. [3] [4] [8]

Programme features (4). Medical-home integration and continuity; defined conversion/EMS rules; equity and interpreter access; remote-monitoring governance with thresholds and responders; clinician webside-manner training; documentation standards for exam limits. [1] [2] [7] [14]