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Assist in Medical Office Telephone Evaluation of Patients with Possible Influenza for Health Care Settings

Key points

  • The flow chart is designed to be used when influenza viruses are circulating in the community.
  • This tool may help medical office staff triage calls from patients with flu-like symptoms and identify when it might be appropriate to initiate antiviral treatment before an office visit.

Strategies

Patient triage or prescribing of prescription medicines should be done under the direction of a licensed physician or other licensed provider. More information is available at Influenza Antiviral Medications.

Algorithm to Assist in Medical Office Telephone Evaluation of Patients with Possible Influenza
antivirals-protocol-flowchart-updated
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A flow chart that shows how medical staff can triage and treat patients who call the office with flu-like symptoms.
This flow chart is designed to be used when influenza viruses are circulating in the community. It may help medical office staff assess calls from patients and when it might be appropriate to start antiviral treatment before an office visit.

For Administrative Staff: Does the caller report new fever, cough, body aches, and/or sore throat? If Yes, refer the caller to Clinical Staff. If No, follow office protocol.

For Clinical Staff: Is there a life-threatening OR urgent health condition? If Yes, call 911/Go to an emergency department (ED) now. If No, does caller have influenza signs and symptoms*? If No, follow office protocol. If Yes, is the caller a high-risk patient** or patient with severe or progressive illness? If No to high-risk patient:

Antiviral treatment may be considered on the basis of clinical judgment for previously healthy, symptomatic outpatients.

Treatment should ideally be initiated within 48 hours of illness. One randomized placebo controlled study suggested that treatment initiated 72 hours after illness onset among febrile children with uncomplicated influenza reduced symptoms by a day.3

If Yes to high-risk patient:

Patients at high risk** for complications from influenza and patients with severe, complicated, or progressive illness should be treated with antivirals as soon as possible. To facilitate early initiation of treatment, schedule appointment with patient today OR consider providing an antiviral prescription without testing and before an office visit. Because of the importance of early treatment, decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza. Treatment should be initiated within 48 hours of illness onset, if possible. Treatment initiated more than 48 hours after symptom onset may still be beneficial for severely ill and hospitalized patients.1-2

*Influenza signs and symptoms typically include:

  • Fever: A 100.4°F or higher temperature or feeling feverish/chills AND one or more:
    • Cough
    • Sore throat
    • Headaches and/or body aches
    • Difficulty breathing or shortness of breath
    • Fatigue
    • A runny or stuffy nose

If the patient does not report having a fever or feeling feverish, but had abrupt onset of other symptoms, consider influenza and proceed with protocol.

Show Text Description

* Flu-like symptoms

Keep Reading: Signs and Symptoms of Flu

** High-risk patients

Keep Reading: People at Increased Risk for Flu Complications
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Content Source:
National Center for Immunization and Respiratory Diseases (NCIRD)
  • Malosh RE, Martin ET, Heikkinen T, et al. Efficacy and Safety of Oseltamivir in Children: Systematic Review and Individual Patient Data Meta-analysis of Randomized Controlled Trials. Clin Infect Dis. 2017 Nov 23. doi: 10.1093/cid/cix1040. [Epub ahead of print]
  • Dobson J, Whitley RJ, Pocock S, et al. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet. 2015 May 2;385(9979):1729-1737.
  • Fry AM, Goswami D, Nahar K, et al. Efficacy of oseltamivir treatment started within 5 days of symptom onset to reduce influenza illness duration and virus shedding in an urban setting in Bangladesh: a randomised placebo-controlled trial. Lancet Infect Dis. 2014; 14(2): 109-18.
  • Venkatesan S, Myles PR, Leonardi-Bee J, et al. Impact of Outpatien Neuraminidase Inhibitor Treatment in Patients Infected With Influenza A(H1N1)pdm09 at High Risk of Hospitalization: An Individual Participant Data Metaanalysis. Clin Infect Dis. 2017 May 15;64(10):1328-1334.
  • Muthuri SG, Venkatesan S, Myles PR, et al. Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a metaanalysis of individual participant data. Lancet Respir Med. 2014 May;2(5):395-404.
  • Hsu J, Santesso N, Mustafa R, et al. Antivirals for treatment of influenza: a systematic review and meta-analysis of observational studies. Ann Intern Med. 2012 Apr 3;156(7):512-24