NHS 24 urged to change bleeding patient protocol

SCOTLAND’S out-of-hours health advice line NHS 24 has been urged to change how it deals with patients who are suffering from bleeding when they call.

Retired public health consultant Dr John Womersley has spent several months trying to get NHS 24 to rethink its protocols following the case of a patient who was told she would have to wait an hour and a half for a return call from a doctor after she started suffering bleeding following cervical surgery.

NHS 24 said its protocols were constantly under review and advice was based on the symptoms reported by the patient. Dr Womersley, who was a doctor in Glasgow for almost 30 years, contacted NHS 24 after he became aware of the patient, who called with concerns after bleeding heavily.

The patient had undergone a procedure known as LLETZ – large loop excision of the transformation zone – to remove pre-cancerous cells from the cervix.

The patient, who asked not to be named, said: “When you phone NHS 24, you go through this algorithm thing, so you just go through this flow chart and there is not a lot of room for qualitative detail.”

The call handler said, based on the information given, that a doctor would call her back within 90 minutes. The doctor called back after 40 minutes and the patient was told to go straight to hospital. But she had lost so much blood that she collapsed in the car park and later needed a blood transfusion.

Dr Womersley said: “When we were students, nurses and doctors were told never to run in hospital unless there was a fire or a haemorrhage. So, years ago, we understood that haemorrhage was something that should be attended to immediately.”

NHS 24 told Dr Womersley that the advice given to patients was based on symptoms at the time of the call. But he said: “The analogy is like someone falling from a roof. You feel fine between the 11th and fifth floor, but the disaster happens after that. With heavy bleeding, you can go from feeling reasonably well to shock in seconds.”

Dr Womersley said he was told that the protocols used by NHS 24 when dealing with emergency calls were continually under review. But he added: “I think it is dreadful the way they have treated my attempts to get them to look at their protocols.”

NHS 24 said it could not comment on individual cases due to patient confidentiality. It was also unable to give details of its protocol on heavy bleeding as the information was owned by its “clinical content supplier”.

NHS 24 medical director Professor George Crooks said that the service “deals with every call on a case-by-case basis and outcomes are dependant on the symptoms a caller or patient presents at the time of the call.

“Many calls are referred onwards for clinical assessment and treatment, and for those callers who are given self-care advice, or who may be waiting for a call back from a clinician, they are always … asked to call back immediately if their symptoms become more acute.”