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CPD: Key questions on out-of-hours care

Urgent care GP Dr Matthew Booker discusses ambulance delays, using NEWS2 and managing psychiatric emergencies in the out-of-hours setting

Learning Objectives

This module will take you through some top tips for working in the out-of-hours setting, including:

  • Using NEWS2 scores
  • Doing telephone triage safely
  • Managing psychiatric emergencies
  • Handling requests for drugs that might be abused

Author

Dr Matthew Booker is an urgent and unscheduled care GP and clinical lecturer at the University of Bristol

Recent guidance suggests GPs should use the NEWS2 tool to assess urgency when conveying information to ambulance control. How useful and validated is this, how does it work and how much better is it than GP judgement?

Research is under way into the use of NEWS2 in primary care and community settings, but it remains, as yet, ‘unvalidated’. Indeed, practitioners of all flavours have their doubts about how appropriate this scoring system is in these settings. However, there is a need for common language around priority, and evidence suggests the risk of failing to identify deteriorating patients is greatest at the handover between organisations or care providers.

There is good evidence for the use of NEWS2 in patients with (or at risk of) sepsis in secondary care settings.1 Tools such as NEWS2 may be best considered adjuncts to ‘clinical gestalt’ and as a way to help communicate the urgency of a particular request; they certainly do not replace GP judgment. However, in line with NICE quality standards for sepsis2, NEWS2 does provide for a structured assessment of observations, and may be helpful in highlighting which patients are at most risk of deterioration. NEWS2 may be more useful for less experienced clinical team members but doesn’t trump GP concern. Like any numerical scoring system it can fail to recognise poorly people who are compensating well physiologically, or over-identify those whose functional baseline physiology is abnormal. Until research can inform exactly how well it suits this setting (and what the escalation triggers should be) it is perhaps best seen as just part of the picture that we paint at handover to other services.

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