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Coroner calls for changes to NHS 111 following death of young adult

A coroner has called for a change to NHS 111’s telephone triage service following an inquest into the death of a 17-year-old boy.

Alexander Davidson, 17, died in February 2018 of an infected and necrotic pancreatic pseudocyst. He had four telephone triage assessments by NHS 111, two admissions to a local A&E, and made contact with his GP on three occasions.

The coroner, Laurinda Graham, said that it was ‘unlikely’ that different treatment would have prevented Mr Davidson from dying, but there was a possibility that Mr Davidson may have had problems understanding some of the ‘medical terminology’ in the questions he was asked over the phone and may have miscommunicated his symptoms.

The report also said that the NHS Pathways algorithm for triaging vomiting and diarrhoea symptoms is unclear as patients may fail to understand what is meant by ‘soil’ or ‘coffee ground’ vomit – and such a distinction can be vital.

Mr Graham called on NHS 111 to think about altering the wording of the questions depending on the age and condition of the patient.

The helpline had a troubled beginning when it was introduced in 2013, with many GPs criticising its use of non-medically trained call handlers to ask questions.

In recent years, NHS England has introduced greater clinician presence within the call centres, but the majority of patients still only speak to the non-medically trained call handlers who use NHS 111 Pathways to triage patients.

The coroner’s report, first reported in the HSJ, read: ‘The NHS 111 telephone triage service uses the NHS Pathways computer system to triage patients via pre-determined question/answer based algorithms. The pre-determined questions are the same whether the caller is an adult or a child.

‘Alex struggled to comprehend some of the medical terminology used during these calls. Call handlers are not permitted to deviate from the prescribed wording of the pre-determined questions, and this created confusion and inconsistency in the patient’s answers.’

Ms Graham concluded: ‘Consideration should be given to how this important diagnostic feature can be explored during telephone triage, especially when the patient is young and/or vulnerable.’

There was also an issue with the uploading of the NHS 111 triage report at Mr Davidson’s GP surgery.

The report said: ‘There was a delay of seven days in the GP surgery uploading the 111 triage document to Alex’s patient record. This prevented Alex’s GP from reviewing the triage note prior to his consultation with the patient. There is no guidance as to expected practise with regards to the timely updating of electronic patient records, and as a result delays are all too frequent.’

Last month, a Pulse survey found GPs in England receive more than a quarter of a million inappropriate referrals from NHS 111 every month. This amounts to an average of 6.2 inappropriate referrals a month per GP. The BMA said the efficacy of the service needs to be questioned and scrutinised.

Readers' comments (10)

  • Or just pay for some professionals.
    Either way, it should be made completely clear to callers that call handlers have no medical training whatsoever.

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  • If you want clinical triage. You need to pay for it. With professionals. Like everything in life.

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  • It is often better to eyeball the patient, telephone triage can miss desperately ill patients while a sight of then gets them blue lighted to safety.

    Good and safe medicine cannot be done on the cheap.

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  • You get what you pay for. If 111 call handlers cannot help, I doubt AI will help. There will be more cases. Face to face is giving best possible care and if that is what the country wants, then it should pay for it, otherwise stick with the next best thing.

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  • Vinci Ho

    and backlashes The truth can only become more apparent , the more the matter being subjected to debates
    After so long , if stakeholders still insist on this kind of the cheapest model of triaging( considering even the older model of NHS Direct was contentious) as the legacy of austerity from this Tory government, they can only expect more criticism and backlashes from all directions.

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  • Vinci Ho

    Apology of the typing error of the first two words

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  • Medicine is an art not a science. Algorithms are never going to be as safe as eyeballs. Nothing more needs to be said.

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  • NHS 111 as unsafe as always......this weekend on call- 71 yr old man, temp 38.9C, abdominal pain, diarrhoea, feeling generally unwell- NHS 111 algorithm 4 hr home visit- upgraded to 999 Ambulance for upon receipt of 'Home visit request' - have NHS 111 not been made aware of sepsis protocols?????? How can you safely assess fever and abdominal pain in an elderly man at home?????? You can't even speak to the call handlers or supervisors to question their triage methods, making their system even more dangerous as they dont learn.

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  • I’m not sure why everyone here thinks this is about money.

    Inflation adjusted the NHS is spending ten times as much as it did when it created.

    Out of hours GP spending went up by 600%-700% within a couple of years between 2003/04 until 2005/06 and has been sustained since.

    Has this meant better care for patients?

    NHS spending continues to rise year on year, other areas of spending are squeezed and is healthcare improving?

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  • The above incident emphasises education on the part of both patient and 111 call attender. I regularly see patients who are told on telephone triage to be seen within 2 hours. I have no come across a single patient who required immediate attention.The problem with NHS is running of the system at highest level. Any MP irrespective of his or her background becomes health secretary. The worst scenario is when problems are not accepted at the highest level in central government.

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