How ‘telephone triage’ could help hospitals

Fresh ideas should free up bed space at the Western General. Picture (posed by model): Ian Georgeson

A hotline will be set up at the Western General to allow GPs to book next-day appointments for patients rather than send them straight to hospital.

It is one of series of initiatives being looked at in a bid to free up vital bed space and reduce waiting times at the city’s hospitals.

Health bosses believe an overhaul of how patients are referred to NHS Lothian sites will ensure people are seen by the most appropriate department in the first instance.

It is hoped a raft of measures – including the telephone triage service – will also go some way towards stopping waiting rooms from clogging up.

David Caesar, clinical director for emergency medicine at NHS Lothian, said the idea behind the re-modelling was to provide patients with the most efficient and appropriate care.

He said each of the board’s sites – like the ERI, St John’s and the Western General – had their own specialities and the proposed revamp was about ensuring patients were quickly sent to the best-matched service. “What we’re trying to do is make it more efficient, schedulise unscheduled activity a bit more in a more pre-emptive fashion and make the patient experience as good as possible,” he said.

“We’re really trying to match the patient demand so that if you are directed towards any of these hospitals, you know you are seeing the best that Lothian can do for you, as well as trying to keep you as local as possible.

“There are lots of different types of patient and the way they turn up at hospital can be a little bit confusing both for patients and clinicians, ambulance drivers and for relatives.

“The way that things are happening at the moment is the way that things have been for some time and nobody is doing anything wrong.”

Phone consultations, set to start in December, would give GPs more information about where best to direct patients and also speed-up the process when anyone did need to be admitted.

Dr Caesar said the system would help medics plan some of the city’s unscheduled care by providing community doctors with instant access to specialist expertise.

“If a GP thinks a patient needs admitting, they are nearly always right so the idea is not to put up a gate-keeping service. If they do think someone needs admitting, there is no point adding steps towards that admission, so we are just going to try and make the process easy. GPs sometimes just want to have some advice about ‘can this patient be seen today or the next day,’ for example to do some investigations that might be best done in hospital, which this would allow for.

“It could help to stream patients as a way of getting them into day hospital or see if there are ways of them avoiding a crisis admission if they are frail.”

Leading health figures admit the Western’s acute receiving unit has been a “poor performer” for months against the national four-hour hour waiting times target. In August fewer than 87 per cent of patients were seen within this time, just as the Scottish  Government prepares to up its target to 98 per cent.

Melanie Johnson, executive director of nursing and unscheduled care, recently told the health board that “a lot of work” was going on at the Western to improve its scores.

“The front door of the Western, the acute receiving unit, is an area that has struggled,” she said. “We are working to change the nature of that unit so while it receives patients who have been assessed by GPs, it’s not receiving patients who are not assessed or who are self assessed. It will do what it is supposed to do rather than taking such a mixture as has developed over time.”

The proposed overhaul of the acute receiving unit, where those in need of emergency care are referred by GPs or paramedics, includes:

• Developing a separate medical assessment unit for patients presenting with acute conditions

• A new surgical observation unit, where specialist nurses and consultants carry out assessments

• Relocating the minor injuries unit within the grounds of the Western

• Extending consultant input across the day at the acute receiving unit to better match demand and reduce avoidable admissions in the evening

Last week the Evening News revealed how crippling levels of bed blocking – when patients cannot leave hospital because there is no other care in place – have left NHS Lothian facing a huge shortage of beds.

Hundreds of operations have already been cancelled as a result of the spiralling number of patients trapped in hospital, with health chiefs warning the problem is likely to escalate this winter.

The rise – culminating in 434 people currently confined to the regions’ hospitals compared with 133 this time last year – is being blamed on a soaring ageing population and a shortage of care home beds.

The situation is so serious that a summit was recently called with experts from across health and social care service from the local authorities to deal with the “unprecedented and unsustainable” situation.

But so far, immediate measures by the health board and Lothian councils have done little to alleviate the issue – which has seen the number of days lost to bed blocking increase by 69 per cent in just 12 months.

Scottish Conservative health spokesman Jackson Carlaw said: “I think this is a sensible move by NHS Lothian, because people ending up in the wrong place is a massive issue for the health service generally.

“However, there’s no walk-in A&E at the Western, so most people who go there are facilitated in some way by the NHS – that means they have the control over the situation.

“It’s important more is done to ensure the only people who end up in hospital are the ones who have to be there.

“The Scottish Government must support NHS Lothian in this move and ensure enough resources are dedicated to it.”

Lothian Labour MSP Sarah Boyack welcomed attempts to ensure appropriate and timely treatment.

She said: “It’s vital that NHS resources are focused to ensure that patients are seen within the four-hours waiting times target.

“Bed blocking and the underlying strain on social care is one of the most pressing issues facing health services in the Lothians right now.”

Warning as vomiting bug returns

hospitalS in the Capital are already facing a winter of discontent.

The Evening News told on Saturday how the winter vomiting bug norovirus has forced hospital chiefs to close wards at elderly care facility Findlay House and at the Western General.

Last year, the season was said to have not started until mid-December, while in 2012 it began in mid-November, causing chaos in hospitals.

But now health experts are warning the superbug has struck earlier than ever – with 14 patients already being treated.

Dr Evonne Curran, infection control nurse consultant, said: “Letting everyone know that norovirus season has started enables preparedness plans to be put in to action.

“Health professionals across NHS Scotland are working to minimise the likelihood of outbreaks arising and the public is being asked to play their part too.”