Clinical support available and 111 Out of Hours

999 111

As part of our closer working partnerships with the 111 providers, we are giving feedback to patient-facing colleagues to help improve the quality of our interactions – and need your help.

We regularly meet with providers to discuss 111 reviews that have be raised by staff, calls sent to us without any 111 clinical input, and calls that crews subsequently discharge care on scene.

As part of this integrated working, the providers give us data around our use of their service to help explore how elements of them can be dealt with more effectively.

One matter identified by both services has been calls made to 111 asking for a GP call back, specifically out of hours (OOH). We have seen prolonged on-scene times whilst clinicians wait for this call-back and 111 providers have seen an increase in calls seeking discharge of care or ‘just for information’ calls, rather than for escalation of treatment.

Your decision about contacting OOHs should be about assisting with escalation of care and treatment above the skillset of the attending clinician but when admission to hospital is not required. Examples include immediate medication such as pain relief or other medications such as steroids or antibiotics. Other examples could include crisis management aimed at patients with complex needs, or end of life care (in the absence of a pre-defined plan).

Although there are many valid reasons to contact OOH services, the Clinical Team would like to emphasise what help is available through the Trust - consider these options first to support your decision making. By working together, we believe delays in waiting for a call-back will be reduced and you will receive more timely supportive advice to best care for your patients.

Internal support includes:

  • Clinical Advice Line (01234 779203 option 1)
    The CAL is run 24/7 by senior clinicians who have access to online resources such as the BNF, Toxbase, PGDs, SystmOne, End of Life plans and alternative pathway knowledge. They can discuss your patient with you to help formulate a plan or support with advice on appropriate pathways. Clinicians who require discharge of care should choose this option. 
  • MiDoS (Directory of Service) and patient care record (01234 779203 option 2)
    This gives advice and support on available pathways within each area, contact numbers, opening times and inclusion criteria. Access to patient care records through SystmOne is available for information on active medical conditions and current medications.
  • Single Point of Contact (SPOC 01234 779203 option 3)
    Through SPOC you can complete a GP notification that is sent to the patient’s GP by 8.00am each day. The SPOC team will record information on the patient’s treatment or care and any suggestions for continuation of care or follow up requirements. Remember to help to empower the patient or relative to self-contact their GP for continuation of care and treatment. Vulnerable adult and child safeguarding referrals are also completed through SPOC.
  • Symptom management
    Think about self-care and a step wise approach to management. Pain relief is a good example: what have they tried for effect, can you escalate management with other over the counter medication? Once this has been completed and fully explored then involvement from a GP might be the next step.
  • Safety netting – This is achieved through good documentation on the patient care record following your assessment. Provide the patient or care giver clear and concise information and advice on pathways/processes if symptoms worsen or any other concerns arise. Remember, calling 111/OOH/CAL and speaking with a clinician does not automatically count as safety netting. 
  • Referral to 111 – If after an assessment you feel the patient would benefit from a different clinician involvement there is not always a necessity to remain on scene. If there is no requirement for a professional to professional conversation then once you have made the call the patient or appropriate adult can take the returning call allowing you to leave scene.

This guidance is designed to aid your decision making and recognise the benefits, boundaries and limitations of each support option.

Calls originating from 111 providers

There is often feedback that a number of calls originating from 111 are inappropriately passed to EEAST for attendance.

Think about and consider the risk and complexity of remote triaging, such as with our Hear and Treat team. Most decisions are based on risk of that assessment which would say ‘an urgent face-to-face assessment is required’. For instance, a chest pain presentation in a younger patient who may say they have classic cardiac symptoms - the risk decision is that despite the likelihood of actual illness/disease might seem low it is still not impossible and so would require a face-to-face assessment.

We are interested to hear about, and review with our 111 colleagues, calls which you think could have been managed in a different way. Please raise these via DATIX and they will be reviewed by EOC, Operations and clinical teams prior to presenting suitable cases at our review meetings with 111.

Published 7th November 2018

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