Review of calls to NHS Direct related to attendance in the paediatric emergency department

Abstract

Objective: To examine the outcomes of calls to NHS Direct (NHS-D) in relation to attendance at the accident and emergency (A&E) department. Design: A prospective collection of data about consecutive calls to NHS-D North West Coast was matched with attendances at the A&E department over a period of 3 months. Setting: NHS-D Regional Trust and a large urban paediatric A&E department. Patients: Children and young adults aged ,16 years living in local postal code areas. Main outcome measures: To examine (1) whether advice given by NHS-D was followed and (2) the differences in disease severity and necessity of attendance of patients referred by NHS-D and those referred by general practitioners and self-presenters. Results: The relationship between the advice given and subsequent action is complex. Only 70% of calls advised to attend the A&E department did so. A further 1% (176) were advised not to attend the A&E department did in fact attend the department. Patients referred by NHS-D represented only 3.2% of department attendances. There was little difference in the triage categories of the presenting groups, but there were significantly less admissions (p,0.01) in the NHS-D group. Conclusions: Delivering telephone advice about illness severity in children is difficult as visual clues are so important. More collaborative prospective studies are needed, including with primary care, to understand families' choices, and to refine and assess NHS-D's ability to discriminate those requiring further clinical assessment.

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

“…Similarly, there has been a reduction in the ability of ambulance services to meet the national target of responding to 75% of life-threatening (Red 1) calls within 8 minutes. Performance nationally reduced from 76 In 2012/13, the intense public scrutiny culminated in a Health Select Committee inquiry, 2 and this scrutiny has continued. The pressure of increasing demand has more recently been exacerbated by acute shortages of associated health-care professionals, particularly in emergency medicine, 3 primary care 4 and ambulance services.…”

“…72 57 also reported on appropriateness and 11 of the studies identified here were included in the review by Blank et al 73,[75][76][77][80][81][82]84,88,90 This review identified that triage decisions rated as appropriate varied between 44% and 98%. However, many different definitions of appropriateness were used, which leads to difficulty when trying to compare results.…”

Reducing inappropriate accident and emergency department attendances:

“…Primary care OR general practice OR GP (these to be nested within terms such as GP co-operative) 12-22 three were eligible for quality assessment. 12,19,20 Four of the eleven studies concluded that telephone triage exerted little effect on A&E attendance. 7,14,15,17 A Cochrane systematic review incorporating six studies of varying service configurations found no evidence of a significant reduction in A&E attendances, with one study (of nurse-led telephone triage) demonstrating an increase.…”

“…12,17 Variations in the observed effect of telephone triage on A&E attendance rates may be attributable to various factors, including differences in triage service design. Studies covered interventions ranging from national telephone triage lines (for example, NHS Direct in the UK) 16,17,20,21 to local advice lines 14 and telephone services embedded within GP cooperatives. 15 Several studies identified poor telephone triage design (for example, unclear clinical algorithms) as explanations for inappropriate A&E referral.…”

Calls to NHS Direct

“…In response to the article by Stewart et al 1 on a review of calls to NHS Direct related to attendance in the paediatric emergency department, we think it would be helpful to set some of the findings in context.…”