Nottingham Children’s Hospital senior telephone advice
Started: Formally in September 2015, Pilots and partial implementation from 2012/2013
Region: East Midlands – Nottingham City and South Nottinghamshire
Estimated local pop. 0-18 years: Nottingham City 59,000, South Nottinghamshire 102,000
A project team working on improving the pathway for emergency medical admissions identified that when a GP called with concerns about a child, the call was taken by a junior doctor and always resulted in the GP being advised to send the child into the Children’s Assessment Unit (CAU).
The team hypothesised that if the calls were taken by someone senior, (with more extensive paediatric knowledge and experience than the GP making the call), it might be possible to have a more proactive discussion and identify some appropriate options which didn’t involve a same-day attendance in the CAU.
To ensure that acutely unwell children are managed in the appropriate setting with optimal management: either in primary care, rapid access outpatient clinics or as an acute attendance to hospital.
Target patient groups
Under 19 year olds with a medical problem (usually acute)
The service model
Using the ‘hot-week’ consultant rota for emergency admissions, this consultant also became responsible for taking the GP calls.
Simple paperwork was developed using the SBAR format.
Monday to Thursday 0845-2115. Friday 0845-1915
As part of a complex hot week, second on week and third on week depending on the time of year.
Who can referGPs (not nurse practitioners) and midwives if it is for jaundice or weight loss
Who is accountable for patients
GP or midwife unless sent to hospital
Local CCG now (previously ‘Dragons Den funding’)
Level of patient/family involvement
No patient involvement
Level of integration in the system
- The trial ran for one week and found that 30% of patients didn’t need to attend the CAU that day.
- Some were diverted to routine outpatient or rapid-access clinics
- Some were managed by the GP with the advice from a consultant
- An additional, unexpected outcome was that 2 patients were escalated to a 999 ambulance call due to the telephone conversation
- In some practices, the clinical discussion prompted the GP to change practice or purchase equipment (e.g. pulse oximeter)
- Following trials, the change was fully implemented and analysis of the paediatric calls has shown:
- 63% of calls are sent to the CAU
- 13% of calls are referred to a rapid-access clinic
- 4% of calls are referred to routine outpatient clinics
- 15% of calls go on to be managed by the GP with the advice given by the consultant
- 4% of calls are escalated
Challenges, successes, lessons learned and advice
- Know what happens to your GP admissions
- Work out whether the attendances are appropriate
- Pilot it over a period of time and see if it changes the practice
- Implement it keeping figures
- GP phone calls tend to be clustered around 1030 – 1300 and then 1530-1830. Any service needs to be able to cope with these peak times
- A consultant cannot do a ward round and take GP calls simultaneously
- GP education has improved over time and the phone line allows discussion about every acutely unwell child that a GP wants to admit which in turn improves the general paediatric knowledge of GPs in a more consistent way than having a paediatrician based out in single practices or groups of practices. In particular it becomes possible to identify which GPs struggle to manage acutely unwell children and allows further training
There is a danger that the service is used as a pharmacy information line, a GP trainee support system etc and so we make it clear if a phone call is inappropriate and suggest alternative ways to gain the knowledge (like a BNF!) and we always ensure that GP trainees have spoken to a qualified GP
Contact for more information
Louise Wells, Consultant paediatrician, Louise.email@example.com
In: Case studies