>From: Robbie Coull <[log in to unmask]>
>I notice Which Health shares my concerns about NHS direct's system of call
>handling
>(http://news.bbc.co.uk/hi/english/health/newsid_869000/869715.stm).
>
>However, it should be remembered that A+E depts and GP OOH services provide
>variable telephone advice as well.
But that does not mean we need another telephone service to do as badly! The
whole point is that the telephone itself is inefficient so long as the LAY
patient is at the one end! No-one, I am sure, thinks the staff at NHSD are
to blame - they are just as ineffective as A&E/GP set-ups are on the phone.
>I've been present in the room when an Paediatric SHO in A+E told a mother
>of
>a child with a rash post-antibiotic to call their own GP only to have the
>GP
>send in the child 999 30 mins later with meningicoccal septicemia. I was
>present when a GP receptionist put a "suddenly pale and floppy baby" in to
>the visits book for later in the day - I went right away and the found the
>baby to be profoundly shocked with a strangulated inguinal hernia. I've
>made several mistakes as well and healthcall was also recently criticized
>for it's call handling.
>
>NHS direct is easier to audit, monitor and correct than thousands of
>different points of contact all quietly making the same mistakes as each
>other. This is a good thing and should not be seen as a flaw.
>
>But the software and staff training used may leave a lot to be desired.
>Apparently the English NHS direct sites use one of 4 software systems. The
>Scottish Office is just finalizing it's choice of software systems from a
>tender started earlier in the year. The impression I got from speaking to
>the Scottish Office is that these systems have been developed by software
>houses with help from medical advisors rather than the other way around.
It is also a fact! All HAVE been developed by software people. The idea
behind these systems, no matter how much one twists it, is to reduce
workload by eliminating as many visits as possible. There is no-one in
government, trying to be re-elected, who would advocate a system which has
as ITS MAIN AIM the safety of those patients Robbie has skilfully managed to
save from mis-adventure. With this bias driving the program, it will fail to
live up to the medical point of view.
>That is a serious error. I think they know this but have been given an
>impossible timetable for implimentation.
>
>I spoke to the Manchester Triage Group last year about developing their A+E
>triage for telephone use, but they have all been tied up on other projects
>and it seemed to be difficult to interest them in this
Manchester Triage is another painful point... Where is the evidence to back
it as a useful system to adopt? I have none. Personal experience has placed
me squarely against it.
>Jeremy, do you have any info on the systems in use and how they have been
>developed? I've got my telephone version of the Manchester Triage which
>works fine for me in remote settings, but does not cover a lot of other
>stuff (such as requests for repeat prescriptions etc.) that I handle
>intuitively. Is anyone else working on this kind of thing?
>
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