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Potential for advice from doctors to reduce the number of patients referred to emergency departments by NHS 111 call handlers: observational study
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  • Published on:
    The analysis makes no comparison with a baseline position and is selective in reporting only some costs
    • Henry Clay, Management Consultant Primary Care Foundation

    The need to compare with a Baseline
    The analysis describes how cases were chosen "where the NHS Pathways software indicated that a patient should be instructed to go to an A&E department" (so dispositions to an emergency department with codes such as Dx02 or Dx03) and how "the call handler told the patient that they would be called back by a GP".
    However, as part of the normal process in NHS 111 a further conversation takes place with the patient after the Dx code has been generated during which the specific location of the service that the patient should attend is agreed. As this is done a number of callers are directed to WIC, MIU etc. and to other services. The exact level will depend on various factors, most noticeably the number and location of these alternative services, but analysis from elsewhere of the referrals by call-handlers to Emergency Departments with a time frame of 1 and 4 hours (Dx02 and Dx03) concluded that 15% of those cases go to WIC + MIU 3% to other services, whilst perhaps 7 or 8% were referred to the ambulance service (so may well have been transported to the Emergency Department).
    Since, in the study, this conversation with the call-handler was effectively delayedto the later conversation with the GP the comparison should have been with a baseline case, not simply with the nominal NHS Pathways disposition. It seems likely that the impact if the authors had compared with a baseline period using informa...

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    Conflict of Interest:
    None declared.
  • Published on:
    Emergency Department referrals from NHS 111
    • Steven Rawstorne, NHS 111 National Medical Advisor
    • Other Contributors:
      • Jonathan Benger

    Anderson and Roland offer a useful contribution to the question of how telephone requests for help and advice through NHS 111 should be assessed.[1] We agree wholeheartedly with their conclusion: "our results demonstrate the need for further research to establish the cost effectiveness of different approaches to triaging telephone requests for care".

    Such work is already under way, through the NHS 111 Learnin...

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    Conflict of Interest:
    None declared.