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Improving Outcomes by
Implementing a National
Telephone Triage Service

             Dawn Orr, Nurse Consultant, Clinical Decision
             Making
National telephone triage service for
patients receiving or recently completed SACT or
radiotherapy

  Aim of the session…
  Share….Background, Context, Future
  Describe work carried out so far
  Describe the next steps
  Raise the profile and sense check
Background

• Nationally consistent telephone triage
  service

• Reports/Policy/Publications/ Directives

• Short life working group
Front End: NHS 24 – Cancer Team Model                                                                     V 0.2 – 05.03.12
On commencement of treatment every patient is issued with an ‘alert card’ based on the template set out within the NPS BPS
which advices the patient to call NHS 24 – Cancer Team if the patient has a healthcare concern



  Patient at home                  NHS 24 – Cancer                         Patient is                   Patient is managed
  has a healthcare                  Team answer                          Triaged using                     according to
      concern                                                            UKONS Tool                         triaged alert




 Patient or carer                 NHS24 – Cancer                     Call Handler takes                 Green – Advice
 follows the ‘alert               Team – Call                        the patients details.              given
 card’ and calls the              Handler asks the                   Call Handler talks                 Amber – Follow up
 dedicated number                 NHS24 standard                     the caller through                 after 24hrs by NHS
 for the NHS 24 –                 initial questions. If              the UKONS Triage                   24 – Cancer Team
 Cancer Team                      serious health                     tool.                              Double Amber or
                                  concern advices                    Completed tool is                  Red – Assessment
                                  caller to Dial 999                 electronically auto -              required within
                                                                     shared with the                    secondary health
                                                                     prescribing team.                  care setting.

         Call Hander [Band 2 AfC] supervised at all
         times by Senior Staff [Band 6 AfC] on a
         maximum 5:1 basis.                                                                  It is the responsibility of each
         All Cancer Team staff complete competence                                           NHS Board to determine and
         based training.                                                                     share with NHS 24 how that
         All call are monitored and audited.                                                 assessment will be managed
Referral On: Management Within Secondary Care Model                                                          V 0.2 – 05.03.12
On commencement of treatment every patient is issued with an ‘alert card’ based on the template set out within the NPS BPS
which advices the patient to call NHS 24 – Cancer Team if the patient has a healthcare concern



 Patient triaged         Patient referred to          Patient attends          Initial treatment /           Patient managed
 using UKONS              secondary care              secondary care           management plan                by Prescribing
      Tool                by triage service           for assessment             implemented                       Team




Double Amber or          Each NHS Board             Receiving Service          Initial treatment /        Patients ongoing care
Red – Assessment         has responsibility         assess the patient         management                 is transferred to the
required within          to have an identified      and develop an             options:                   Prescribing Team
secondary health         Receiving Service          initial treatment /        • discharge with
care setting             to accept referrals        management plan            agreed follow up
                                                                               • admit to general         Effectiveness of
                                                                               medical ward of            model will be
                                                                               attending hospital         reviewed:
There is national        Receiving Service provided by NHS Board will:         • admit to cancer          • Audit
consistency with all     • Meet a set of minimum clinical standards that       centre                     • Patient Experience
front door services      match the NPS BPS(2011), the future CEL               • admit to ITU             • M+M Review
using the UKONS          (2012) and the UKONS (2012) AO Guidelines
traige tool:             • Have capacity to manage multiple referrals
• NHS 24                 Receiving Service model could be:
• Primary Care           • Acute Oncology Team                                 Priority is for at the earliest point all treatment
• Emergency Care         • Oncology Emergency Assessment Area                  / management transfers from the Receiving
• Other?                 • Emergency Medical Assessment Team                   Service to the patients Prescribing Team
Benefits

•   Safe reliable triage tool
•   Dedicated phone number/ cancer
•   Dedicated Secondary care
•   Audit trial to support quality and demand
•   Robust governance framework
•   C ost effective
•   Timely access to Acute Oncology Service
Next steps
•   Preparation of training programme
•   PID development
•   E health input
•   Sharing electronic records
Thank you

Dawn.orr@nhs24.scot.nhs.uk
scott.taylor@scotland.gsi.gov.uk

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Parallel Session 4.4 My Pathway, My Choice

  • 1. Improving Outcomes by Implementing a National Telephone Triage Service Dawn Orr, Nurse Consultant, Clinical Decision Making
  • 2. National telephone triage service for patients receiving or recently completed SACT or radiotherapy  Aim of the session…  Share….Background, Context, Future  Describe work carried out so far  Describe the next steps  Raise the profile and sense check
  • 3. Background • Nationally consistent telephone triage service • Reports/Policy/Publications/ Directives • Short life working group
  • 4. Front End: NHS 24 – Cancer Team Model V 0.2 – 05.03.12 On commencement of treatment every patient is issued with an ‘alert card’ based on the template set out within the NPS BPS which advices the patient to call NHS 24 – Cancer Team if the patient has a healthcare concern Patient at home NHS 24 – Cancer Patient is Patient is managed has a healthcare Team answer Triaged using according to concern UKONS Tool triaged alert Patient or carer NHS24 – Cancer Call Handler takes Green – Advice follows the ‘alert Team – Call the patients details. given card’ and calls the Handler asks the Call Handler talks Amber – Follow up dedicated number NHS24 standard the caller through after 24hrs by NHS for the NHS 24 – initial questions. If the UKONS Triage 24 – Cancer Team Cancer Team serious health tool. Double Amber or concern advices Completed tool is Red – Assessment caller to Dial 999 electronically auto - required within shared with the secondary health prescribing team. care setting. Call Hander [Band 2 AfC] supervised at all times by Senior Staff [Band 6 AfC] on a maximum 5:1 basis. It is the responsibility of each All Cancer Team staff complete competence NHS Board to determine and based training. share with NHS 24 how that All call are monitored and audited. assessment will be managed
  • 5. Referral On: Management Within Secondary Care Model V 0.2 – 05.03.12 On commencement of treatment every patient is issued with an ‘alert card’ based on the template set out within the NPS BPS which advices the patient to call NHS 24 – Cancer Team if the patient has a healthcare concern Patient triaged Patient referred to Patient attends Initial treatment / Patient managed using UKONS secondary care secondary care management plan by Prescribing Tool by triage service for assessment implemented Team Double Amber or Each NHS Board Receiving Service Initial treatment / Patients ongoing care Red – Assessment has responsibility assess the patient management is transferred to the required within to have an identified and develop an options: Prescribing Team secondary health Receiving Service initial treatment / • discharge with care setting to accept referrals management plan agreed follow up • admit to general Effectiveness of medical ward of model will be attending hospital reviewed: There is national Receiving Service provided by NHS Board will: • admit to cancer • Audit consistency with all • Meet a set of minimum clinical standards that centre • Patient Experience front door services match the NPS BPS(2011), the future CEL • admit to ITU • M+M Review using the UKONS (2012) and the UKONS (2012) AO Guidelines traige tool: • Have capacity to manage multiple referrals • NHS 24 Receiving Service model could be: • Primary Care • Acute Oncology Team Priority is for at the earliest point all treatment • Emergency Care • Oncology Emergency Assessment Area / management transfers from the Receiving • Other? • Emergency Medical Assessment Team Service to the patients Prescribing Team
  • 6. Benefits • Safe reliable triage tool • Dedicated phone number/ cancer • Dedicated Secondary care • Audit trial to support quality and demand • Robust governance framework • C ost effective • Timely access to Acute Oncology Service
  • 7. Next steps • Preparation of training programme • PID development • E health input • Sharing electronic records

Notas del editor

  1. 1/ Pts currently receiving or recently finished SACT Variation in national practice, scope to improve pathway, increasing cost and incidence of cancer 2/ Reports - National Confidential Enquiry into Patient outcome and death (2008)- pts require prompt access to specialist care when illness arises. Recommendation access 24 hour telephone helpline, UKONS evaluation recommends 24 hour telephone triage toolkit be intro nationally, Best practice statement neutropenic sepsis – 24 hr tele access and prompt admission if required Policy- SGHD, Better Cancer Care (2008), Quality Strategy (2010), NHSScotland Efficiency and Productivity Framework Publications – Flannery (2009)- examining telephone calls in ambulatory oncology – Journal of Oncology Practice King (2011) Towards saving a million bed days, reducing length of stay through an acute oncology model of care for inpatients diagnosed as having cancer Mistry (2012) Systematic review of studies of cost effectiveness of telemedicine and telecare. Journal Telemedicine and Telecare Directives- SGHD(2011) Best practice statement neutropenic sepsis, CEL 6 (2012) National cancer quality programme/ guidance of the safe delivery of systematic anti cancer therapy 3/ SLWG- nominations sought from regional networks, NHS 24, Emergency medicine and primary care. 16 nominations (8 deputies). Initially 2 groups- focus on front end service, onward referral and management- became one