NHS Pathways

“The 111 algorithm has been subject to modification in the light of these events, but I remain concerned that there is: a. no detailed assessment of the degree of parental concern”

“In circumstances where paramedic attendance is delayed due to demands on the service. Whilst using NHS Pathways, the health advisor may not be aware of delays within the 999 service. This information is held on the 999 providers host system and does not influence the NHS Pathways triage. Once an ambulance disposition is reached, the disposition script can be amended by a provider or local SOP to require health advisors to give further information depending on the circumstances. Demand management”

“We have broken down our response to the concerns raised and details of measures in place and actions taken and ongoing in this area as detailed below: A) Triage of symptoms NHS Pathways triages symptoms presenting at the time of the call and directs patients to the most appropriate services based on these symptoms rather than making a diagnosis. NHS Pathways is built on a clinical hierarchy of symptoms, meaning that life-threatening symptoms are prioritised and assessed through our initial set”

“The free text box could be set up so that identified symptoms, where appropriate, could generate an automatic red flag. By way of illustration, a non-blanching rash could automatically justify immediate hospital admission by ambulance in a case of suspected meningitis. Similarly, in this case, where a number of sepsis indicators were present, a red flag could have been raised requiring the call advisor specifically to consider a sepsis pathway. This would act as a second level of security, the first”

“call handlers receive significant training in questioning and listening skills during initial core training and through ongoing training updates. This is supported and monitored through monthly call audit. This training and on-going monthly call audit are all mapped to the NHS Pathways Competencies.”

“Call handlers using NHS Pathways are always trained to speak directly with the patient when it is a 3° party call, this ensures that the questions being asked are answered as accurately as possible to ensure both a safe outcome and that questions are not mis-interpreted through a 3 party.”