Sunday, January 28, 2007

Crystal Bollocks

Me in my Vaudeville days



The skill that would help me most in my day-to-day work, and would almost certainly keep my sanity levels reasonably high, is clairvoyance. I wish I could divine the future, guess what was coming next. The Nurse Advisors have an easier time of it. They pick their calls from the queue. There's a surname, age, and brief call reason. We're instructed to keep call reasons short while giving as much info as possible, here are some examples:



  • D&V, LHS ABDO PAIN, FEVER - 2 DAYS

  • PAIN/SWELLING POST XLA YESTERDAY. SX WORSENING

  • PV BLEED, PELVIC PAIN TODAY -TOP AT 10/40 4WKS AGO, LMP 3MTHS

  • SLIGHTLY SOB ON EXERTION, DX CHEST INFECTION& RX ABX 3 DAYS AGO

So, from the top we have:



  • Diarrhoea and vomiting, with left-sided abdominal pain and fever for two days.
  • Pain and swelling after a tooth was extracted yesterday under local anaesthetic. Symptoms worsening with time.

  • Vaginal bleed with pelvic pain. Patient had an abortion four weeks ago, at 10 weeks gestation, and her last period was three months ago.

  • Shortness of breath on exertion, diagnosed with a chest infection three days ago, and prescribed antibiotics

So the nurse sees the call reasons, any notes we've made on the chart, then calls and speaks to the patient. On the other hand we're going into the whole thing blind. This wasn't as much of a trial when I took thirty calls a shift, now I could top eighty if I was on 'ready' all the time. When the 'beep' sounds in my ear, and I look at the phone display, all I know is whether the call is NHSD, GP or Dental. This could be how the first two hours of my shift goes:



  • "Where do I find a dentist?"

  • "My baby's stopped breathing"

  • "I've dropped a brick on my foot"

  • "Is there a chemist open tonight?"

  • "My dad has chest pain and blue lips"

  • "My testicle is swollen"

  • "Do I qualify for Tax Credits?"

  • "My hair smells funny"
  • "I've just taken 60 Seroxat"
  • "My toddler is choking"
  • "My son's just eaten plasticine"
  • "I've just been stabbed"
  • "I think I'm in labour"
  • "Is MRSA contagious?"
  • "My brother's making me have sex with him. I'm only 13 and my period's late."
  • "My sister's got a purple rash"
  • "I've just found out I have an inoperable tumour"
  • "I keep wetting myself"
  • "I've just been gang-raped and didn't know who to call"
  • "My throat hurts"
  • "My husband has AIDS and didn't tell me"
  • "I'm tired at nights"

  • "Is diabetes contagious?"
  • "I think I'm having a miscarriage"
  • "I've just woken up and my husband is dead in bed next to me"
Twenty-five sample calls there. I could have some of these people on the line for twenty minutes, some for three. The twenty-five I've listed have all been calls I've taken in the past, and sadly most of them are now fairly 'routine' with the exception of the gangrape. I'll probably get a random twenty out of these every single night, most of them will crop up more than once.

The stress of this often seems unbearable. To have to switch from trying to give someone a reason to ignore the voices and put the knife down, to explain why 'smelly hair' is not a reason to call your GP at midnight, is exhausting. I actually don't mind the 'big' calls where it really is life or death, or the queries about finding a dentist or chemist, but the sore throats and tummy bugs can really get me down sometimes. It's hard not to choke back tears when the fifteen year-old girl who took thirty paracetamol as a 'cry for help' two days ago calls with stomach pain and vomiting, or when the daughter of a man with inoperable stomach cancer and violent dementia calls, at the end of her tether, because she doesn't know where to get help. He's hitting her mother, but social services are reluctant to help. After all a psychiatric facility is no place for a dying man, but a hospice or hospital is no place for a potentially dangerous man, who means no harm but doesn't know his own strength. What do you say to the scared young girl who is terrified of telling her parents that she's pregnant again, or the lad who has caught an STI but feels unable to seek help because he's underage and gay.

I know we're an easy service to criticise, and it's simple enough to dismiss NHSD's employees as 'untrained operatives bashing away at a computer', but that really isn't the case. We're all only too aware of what can happen when it goes wrong. Even though NHS 24 is a different service to ours, uses different methods to assess, different algorithms and protocols, it's still telephone assessment and still carries risks.

Unfortunately we aren't psychic or omniscient. At the end of every, single call the caller is told "if the symptoms change or worsen, or you're concerned in any way, call straight back" Why? Because we can only assess symptoms happening now, not in an hour's time, not even in ten minutes. People rarely call back if this happens, I might as well be saying "I am a purple seven-legged antelope. If you enjoyed this call please send me a pizza-cutting wheel and 37p". Why call back when you can drag the whole family to A&E, blame us for not picking up on a symptom that didn't exist an hour ago, and then write to the fucking Daily Mail about it.




The public are confused because of recent press coverage (spoke to five people yesterday, concerned that they'd "be killed" because of our 'incompetence') and think that NHS 24 and NHS Direct are the same organisation and then share stories about how awful NHSD are, and how they once had to wait two hours for a callback about the splinter in their thumb, and "Oooh it could've been me that died!" It's a stressful and demanding job, and one that attracts derision and cries of "close it down, waste of money".

We take approximately half a million calls a month, a figure that's rising steadily, yet one thousand NHSD staff have been made redundant and call centres are closing all over the country. The pressure to perform is immense, and people are leaving in droves. What would these six million people do every year if we didn't exist? I'm the first to admit that telephone assessment is not ideal, but no system is.
A patient could present at A&E with symptoms that appear to be flu, be fully examined by a doctor, and told to rest at home, take paracetamol and keep hydrated. They could die within two hours of TSS or meningococcal septicaemia. My local GP (now retired) was a great doctor, worked in the community for thirty years. He saw a man in his forties who was complaining of chest pain and nausea, doc told the man that he'd feel much better if he wasn't so overweight. He'd seen the man smoking on the High Street the day before, he reprimanded him. The man thanked the doctor, walked out through the waiting room and dropped dead. I know that grief is a terrible thing, and the natural instinct is to blame somebody, but telephone triage is not the cause of all ills in society.
We are the black sheep of the NHS, but when we're dealing with people who are ill, we can't predict the future. People are misdiagnosed at hospitals every day, people become unexpectedly ill and die suddenly, human beings are curiously fragile. Unfortunately we're on the bottom rung, so we take the criticism and accept the blows thrown our way, and move on and try to do our jobs.

I should stop watching the news, reading all medical blogs, and get round to finishing off that Christmas vodka. I'm depressed, a combination of doing my job, and of hearing how worthless said job is every time I see the news or read a website. January blues? I wish.



You're probably as miserable as I am now, so here's something to cheer you up:




Whaddya mean 'Humans only?' Yes, a flu-ridden kitten using the NHS Direct Freeview service.

Posted by Sick Sad Minion at Sunday, January 28, 2007 | | Comments

Tuesday, January 23, 2007

Attention readers!

Yes, I AM gorgeous!


Thought I'd treat myself to a domain, to make up for my abysmal, Towers-bound Christmas and New Year! Ten minutes+Photoshop and I also have a picture to go with my shiny new address.


You can still access it through the usual Blogspot address too.

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Posted by Sick Sad Minion at Tuesday, January 23, 2007 | | Comments

Beauty and the Bitch

It is an unerring law of Nature that any man left within 100ft of feminine beauty products will be compelled to try them. This inevitably leads to disaster for them, and amusement for everyone else.

Mr Smooth

11pm on a dull Thursday night. The familiar 'beep' sounds in my ear, signifying a call. I introduce myself, noting the background noise on the call, it sounds like a wolf being alternately drowned and garrotted. A female voice comes on the line, her tone calm, totally at odds with the background noise. Was she a sociopathic fiend, intent on wreaking vengeance on her male acquaintances?

"I'm calling about my boyfriend. I fell asleep after supper, this left him to his own devices. I realise this was a mistake. I woke up because I heard him screaming upstairs, I was terrified. He was naked with his er... testicles in the bathroom sink. The stupid sod had decided to 'surprise' me. He slathered his bloody balls with Immac, it's been on for 20 minutes! Can you hear him? Prat. Anyway, I just wanted to know if there was anything I could do to help him, I mean, you wouldn't let a dog suffer like that, would you?"

I managed to remain calm, professional, and snigger-free until I had to ask the question "Is the affected area larger than the size of the patient's hand?", at which point the caller and myself dissolved into giggles. Her answer?

"He likes to think so"

Ouch.

Dire Straighteners

Saturdays are rubbish. In Summer it's wasp stings and sunburn, in Winter it's colds and sore throats. Blech. After ascertaining that the windows wouldn't open wide enough for me to leap to my freedom, I decided to carry on taking calls.

"Hiya, my name's Ziggy, I've got a bit of a problem. I've got this really bad burn on my forehead, and it hurts.like you wouldn't believe. Can someone give me some advice about treating it? Hope I don't have to go to hospital or anything."

So I asked him how he'd burned himself, obviously different types of burns are treated differently. A chemical burn is quite different than a scald for example.

"Don't laugh, please don't laugh. My girlfriend's at work today and I'm dead bored, my mates are all out on the piss and I'm skint. I thought I'd kill some time playing on my XBox but it's no fun on my own. You know those things girls straighten their hair with? Well Julie got some new ones, dunno why 'cos she's got about three pairs, so I thought I'd see what's so great about them. I tried to straighten my fringe 'cos it's a bit curly and gets on my nerves, but I've gone and bloody burnt my face now! God, Julie's going to take the piss out of me forever *groan*"

Poor lad. I took his details and promised him a nurse would call him back. However, although I couldn't give him medical advice I did tell him to start straightening his hair about an inch away from his scalp. Not only would this help him to avoid future burns, it would also stop his hair looking lank and floppy!

St Valentines Day Massacre

Picture it, a Sunday night, quarter to eleven. Not much happening, a lot of toddlers with diarrhoea and women with period pains. My Kingdom for an interesting call.

"Oh my God this is awful, you have to help us, we don't know what to do! My boyfriend decided to shave himself..um.. 'down there' with my razor and he's cut himself, there's blood EVERYWHERE! He won't let me call an ambulance 'cos the hospital will send for his Dad, oh no, please help!"

Any attempt I made to get her to describe the injury only made her cry "I'm not putting my hands on his.. y'know..his...!"

The young couple in question were both fifteen. The boy had been bleeding for over an hour and was feeling pretty rough. I transferred them to one of our brilliant nurses, Carol, who tried her best to help them deal with this sticky situation. She managed to get the girl to assess the injury, and after some persuasion to call her boyfriend's Dad to take them to A&E. So everything was OK in the end!


Lads, let these stories be a warning to you. If you're going to do it, do it properly!

Posted by Sick Sad Minion at Tuesday, January 23, 2007 | | Comments

Monday, January 22, 2007

The Bigger Picture - Redux

Like I said earlier, some people don't give you the full story when they call. Sometimes they just forget, sometimes it's deliberate, but it always helps to have as much information about what you're dealing with as possible.

A while ago I took a call from 'Jenny'. Jenny was a bubbly, lively sounding 20 year old. Poor girl had been doing some DIY in her kitchen, she'd stood up too sharply and banged her head. The whole call was punctuated by slightly embarrassed giggles, she really was terribly sweet. She had a small cut from the corner of the cabinet (done it myself, hurts like hell but people are oddly unsympathetic! I now lie and claim I've been attacked by a vampire bat) I ran through the usual slew of questions that we ask on head injury calls. Is your vision impaired? Have you vomited? She said she'd vomited a few times, but this had actually been happening before the knock to her head. Oh really? People- you're going to love this :

me - "Wow, Jenny, it's not your day today is it? Vomiting, head injuries..."

Jenny - "...electrocution..."

me - "ELECTROCUTION?""

Jenny - "Oh yeah, it's the funniest thing! I got a new cooker. The shop wanted £50 to install it, but I'm a student, I haven't got that kind of money. I mean, its electric so I thought I'd just do it myself, it's not like it's gas or anything!"

me - "Go on....."

Jenny - "Well I pulled the old one out, turns out they don't have like.. plugs on, it was attached to the wall. Well the men were coming to take it away so I had to get it out. I grabbed some big scissors to try and cut the wire, and the next thing I know I'm halfway across the kitchen! It was dead weird, there was smoke coming out of my shoe, can you believe it?"

me - "...... No. No I can't......"

Jenny - "My arm feels really funny since then, all tingly. That'll teach me to do DIY when I'm hungover. No wonder I feel so rough today, never again!"

NURSE!!

See, I really do love my job? Who knew that cutting through live mains cables was a bad thing? Bless you Jenny, bless your smokin' little socks.

As ever this post is 100% true, with only the name changed to prevent the innocent. I could write a book filled with stuff like this.

Posted by Sick Sad Minion at Monday, January 22, 2007 | | Comments

Sunday, January 21, 2007

The Bigger Picture

Sometimes it helps to be in possession of all the facts. Last year I took a call from a woman in her mid-thirties, she had mild lower back pain but excruciating thigh pain. She sounded intelligent, funny, one of those callers who make the job a pleasure. Something didn't seem right to me though, I occasionally get these hunches and like to act on them, just in case I'm right. Thigh pain and mild lower back pain only got her a P3, but I had the niggling feeling this was more urgent. Was she sure she hadn't had a recent accident? Could she please try and think of any prior conditions she'd had with similar symptoms? Was there anything at all out of the ordinary that I should know about? She couldn't think. I toddled off and discussed it with the CS, that's how weird I felt. CS said if it was just thigh pain, no calf pain, no shortness of breath or difficulty urinating/defecating then she should be fine to wait for a callback.

Got back to my desk, got the caller back, wrapped up the call and just as I was about to finish the call she came out with this gem:

"Actually, I knew I'd forgotten something! I was supposed to have a baby two weeks ago. Could that have anything to do with it?"

Supposed to? Er... So I asked her "Um.. what happened?", carefully leaving the question open in case the baby had died or something.:

" My due date was weeks ago, stubborn little bugger this one!"

WHAT? NO! If you miss your due date it doesn't just roll round to the next month, it has to come out! So, as calmly as possible I asked if it would be alright if I transferred her straight to one of our nurses for a 'chat'. Lovely, sweet, very-pregnant lady said:

"Thank you so much. Maybe she'll be able to explain this weird pressure sensation too. You've been so helpful"

I'll blame the hormones. Thank heavens for hunches.

I get tons of pregnancy related calls. The following scenario has happened at least ten times to me. Another friendly, polite caller, very calm and complaining of severe lower back/abdo. cramps, passed a mucus plug, felt 'wet', alternating constipation and diarrhoea, 40 weeks pregnant. I asked, as is my job, if there was any chance she was in labour? Her reply almost knocked me off my chair:

"Oh heavens no, don't worry, it's not due till Monday!"

What could I say to that? I pointed out that it was Saturday, and also not uncommon for babies to arrive a couple of weeks either side of their estimated arrival date. She said:

"But it can't come today, who'll look after my other three?"

Wow. I know nature can make some women blank out the trauma of childbirth, but just.. wow. She was the first caller like that, not the last by a long-shot. I transferred her to a nurse, gave a run-down of the symptoms, and hoped we wouldn't have a telephone delivery on our hands!

Posted by Sick Sad Minion at Sunday, January 21, 2007 | | Comments

Saturday, January 20, 2007

NHSD almost killed my baby! or How to access your GP OOH service


GP OOH Services

At evenings and weekends your doctor's surgery will usually be closed. Rather than a GP from your surgery staying up 'on call' all night, surgeries in your local PCT (Primary Care Trust) will usually be contracted out to an OOH provider. These are centralised services, often based at local hospitals, Primary Care or Urgent Care Centres (PCC and UCC) who have a staff of doctors and call-takers. If you need a doctor when the surgery is closed you will need to call your OOH service. You may be triaged or you may get straight through to the UCC/PCC, they will arrange to see you if necessary. home visits are rare and usually limited to the terminally ill or housebound. OOH services prefer to bring the mountain of patients to Dr Mohammed, so you'll be advised to visit them at the PCC/UCC. You'll be assessed, treated, and medicated if necessary.

Sadly many people don't understand this. They remember the days when they 'called out' a GP. They remember this with rose-tinted specs, forgetting the long wait as one GP treats the whole community, the inability to fill the prescription he wrote you until Boots opens on Monday, the sound of breaking glass as someone broke into the GP's car. Ahh, halcyon days indeed.

Joe Public - "I need a doctor out now"
Me - "NHSD offers nurse assessment and advice only. To access your GP OOH service you need to call them"
JP - "But my doctor is closed, they put me through to you!"

But - they put me through to you

No. Just no. I'm fed up of hearing how "NHSD almost killed my baby" because people cannot follow instructions. If you call your GP when the surgery is shut in 99% of the cases you will hear this message on the answering machine:

"The Surgery is now closed. In case of emergency please dial 999 and ask for an ambulance. For medical advice only please call NHS Direct on 08454647 (this bit often repeated, up to three times!). If you have a medical problem that cannot wait until the surgery opens, please call [OOH Number]".

Variations on this include:

"The Surgery is now closed. In case of emergency please dial 999 and ask for an ambulance. For medical advice only please call NHS Direct on 08454647 (lather, rinse, repeat). If you have a medical problem that cannot wait until the surgery opens, please hold to speak to an operator"

or

"The Surgery is now closed. In case of emergency please dial 999 and ask for an ambulance. For medical advice only please call NHS Direct on 08454647 (repeat ad nauseam), If you have a medical problem that cannot wait until the surgery opens, please press #1"

If you're very lucky, dialling your surgery number at weekends may automatically divert you to your OOH provider.


See. No-one was put through to anywhere. In virtually all cases the caller will have taken the very first non-emergency number given to them (ours) and hung up. I'll verify it myself if necessary. I do wonder why they feel the need to give our number twice (or even thrice!) and then hastily garble out the OOH number, no wonder people get confused. Ahem.
I called to get someone's OOH number once, the message gave our number three times, then there was a 'click' sound as if the line had gone dead, but no dial tone. How curious! After waiting 90 seconds the speaker came back on the line and gave the OOH number in a disaffected, barely audible fashion. The original caller wasn't the only one who was upset, I reported the practice to my supervisor and the complaint was forwarded to the relevant PCT. Another fairly frequent occurrence is that the receptionist at the practice will forget to put the answering machine on over the weekend. Even GP receptionists are only human (no, it's true!). If this happens it's easy enough for us to find the relevant OOH service for the caller.

So now you know, if you want your GP then call them, not us! If you want your GP then call them. Don't call us and then scream and shout because you had to wait for a callback. Like I said, if the receptionist at your surgery has forgotten to turn the answering machine on then just call us and ask for the OOH number. Ask at your GP surgery, and keep the number in your mobile in case of emergencies. A GP is the only way of getting a prescription or a diagnosis. We are here to provide 'Health information and advice'.

I've posted this because I'm fed up to the back teeth of people saying "I called NHSD and they made us wait 4 hours for a doctor" or "They failed to diagnose my baby's [illness]" We have no doctors, we don't diagnose, and (the most important thing of all) we can only go on the information that you, the caller, gives us. We don't have access to your medical notes or history. If you fail to disclose something, or exaggerate your symptoms (you'd be surprisd, trust me), we cannot be held responsible if an inappropriate outcome is reached. While we can pass your details to your OOH provider after an assessment if you need to see someone urgently, it's easier for you to access Out of Hours services, and you have a right to use them if you need to. Don't waste their time with ingrown toenails and cold symptoms, but it will almost always be quicker than calling us for advice if someone is genuinely ill. Even if you know it's your local NHSD that deals with your OOH provision, don't call on the 0845 number, use the dedicated OOH number. It might get through to the same place (it probably won't now that NHSD has gone national) but it's a different service and the calls are treated differently.
Even unregistered patients or visitors from other parts of the country can use their local service if they need to see a doctor.

What a load off my chest. Hopefully I won't have to live in fear of hearing "NHSD almost killed my baby/granny/dog!" Then we can get back to the business of giving information and advice, not delivering babies and saving the world!



* The information in this post applies to England only. Scottish OOH services are now handled entirely by NHS24 (the Tartan NHSD) and Welsh services are often handled by NHSD Wales.

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Posted by Sick Sad Minion at Saturday, January 20, 2007 | | Comments

Friday, January 19, 2007

NHSD Explained - part 2

See 'Help' post below for the first part of this post.

Streaming - what is it?

Occasionally you won't need to be called back by a nurse. We 'stream' calls to other places when it's blatantly obvious we can't help you, and waiting for a callback would put you at risk, or be pointless.

  • Pharmacy stream - self explanatory. You've got a meds query but are asymptomatic, or you've run out of meds and are asymptomatic. Maybe you're away in a different part of the country and need to find out where to fill your prescription. Pharmacists are the people to speak to about medications.
  • Dental stream - for non-urgent dental problems, usually not terribly painful or merely cosmetic. Callers will usually be advised to call their own dentist. If they're not registered then we'll give them details of local dentists.
  • GP stream - if you've got symptoms that obviously need treatment then we'll tell you to call your surgery asap. Not much point in waiting for a callback from a nurse to be told exactly the same thing.
  • Urgent Dental stream - if you've got severe dental pain then we'll give you the number of an EDS so you can be treated. This one's quite important as EDS places are very limited, and while you waited for a nurse callback all the appointments would be snaffled!
  • A&E stream - you or someone else is injured (broken arm, head injury), or so ill (vomiting blood, loss of vision) that they need to be seen in A&E. We always advise that if the patient's symptoms worsen en route that the driver pulls over to a safe place and calls 999
  • 999 Ambulance stream - suspected heart attacks, cyanosis, unconsciousness and serious accidents get you an ambulance. We'll call control and give basic details and then transfer you to them.
You can, of course, refuse a stream. We don't offer some of them at certain times, after all there's little point referring you to your GP if the surgery is about to close or it's already shut. Refusing a 'streamed endpoint' will earn you a place in the callback queue. Pharmacy and dental will be downgraded to a P3, GP and Urgent Dental to P2, A&E to a P2 or P1 after discussion with a CS, 999 refusals are transferred to the first available nurse.


OOH Services

As you may, or may not know, NHSD is contracted by some GP and Dental Out of Hours services. This means that as soon as your surgery is shut and you call your OOH number, you'll get through to us. (Other services include Primecare and Dencall). We will introduce ourselves as being from NHSD so that you know who you're dealing with, however the way your call is processed is different than regular 08454647 calls (Triage calls). With GP OOH services you will be triaged as normal, then your details may be sent straight to your on-call service or placed in the callback queue with the rest of the calls. If your call is queued then it will have a shorter callback time than normal triage calls, you will effectively be queue-jumping. The callback time will usually be within the hour for both P2 and P3 calls for GP services. The calls are labelled as GP/Dental OOH in the queue to differentiate them from Triage calls.

Now technically, NHS Direct is supposed to be a one-call service out of hours. If you call and the nurse advisor thinks you need to see your GP urgently then they can send the details straight to your OOH service, so that you don't have to make a second phone call. This is done using a computerised 'technical link' service built into our software. Your OOH service will then call you back and arrange for you to be seen if necessary, maybe even arrange transport for you if you need it. It's a great idea, but it confuses Joe Public. Next time Joe's ill he decides to call us because his doctor is closed. He can't understand why his last call ended with him being seen by a GP at his local Urgent Care Centre, yet when he calls asking for a doctor he is told that NHSD is staffed by nurses. It's a very common mistake, maybe 1 in 6 calls on an OOH shift.
The most common problem by far is when Joe or Josie calls, and irately says "But I called my GP and it put me through to you" when I tell them that to actually see someone that they need to call their OOH service. So read my next post for an explanation, as simple as possible, to clear up confusion.

(Wow. This is a far more Herculean task than I'd envisioned. Part 3 coming soon, my fingers are aching now! (I've written this all in one go, no drafting or editing here!)

Ouch. So we'll make it a date for Sunday then? )

TTFN!

Posted by Sick Sad Minion at Friday, January 19, 2007 | | Comments

Help!

I'd be much obliged if people signed this petition It's a campaign about the proper use of the 999 system. Cheers!

As my gift to you I will guide you through NHS Direct, what it's for, how it works, and when to use it. I'm doing this because people often seem confused about what we do. They think we can make home visits, that we have GPs on staff, or that we're a finite resource. None of the above are true.

What is NHS Direct?

NHSD is a telephone advice service staffed by qualified nurses. They often have a background in midwifery or general nursing, but we also have former district nurses and practice nurses. They're very experienced, and there are a lot of nurses who are unable to carry on more 'traditional' nursing roles due to injury or ill-health, and have been able to return to nursing through NHSD.
The nurses are there to give health advice about common symptoms, medicine interactions, and home care advice. They cannot diagnose or prescribe, as they never see the patients. They are assisted by CAS - the Clinical Assessment System. This is a series of computerised algorithms specific to particular symptoms. It prompts the nurses to ask questions about the patient's symptoms until a final disposition is reached. The dispositions include 'Home Care', 'Routine GP Appointment', 'Pharmacy Advice', 'A&E immediately', '999 Ambulance' etc. There are too many to list! The nurses can also fall back on their years of experience, as well as advice from colleagues or the Clinical Supervisor. The CS is a senior nurse who manages the other nurses, and can give advice to other staff who may be unsure about a call.

I'm a Health Advisor. We are usually the first person you speak to when you call NHSD. It's my job to prioritise/triage calls so that they can be dealt with in order of urgency, just like at an A&E dept. We can also give interim care advice to help you deal with your symptoms while you wait to speak to a nurse. Depending on the urgency of your symptoms we can sometimes refer you straight to your GP, A&E, or Dentist/EDS without your ever speaking to a nurse. Sometimes it might even be necessary for us to call an ambulance for you. As well as all of this we can also find you a GP, Dentist/EDS or Pharmacist in your area, or arrange for one of our Health Information Advisors to call you back if you have a more complex query.

Health Information Advisors perform an important role in NHSD, one which the public are often unaware of. If you've been diagnosed with an illness, or there's a public health alert, or you need to know who to contact for information about any part of the NHS then the HI Team can help. They can send literature to you in the post, direct you to approved websites, and give you details of helplines and support groups in your area.

How does it all work then?

  • You call 08454647 (0845 606 4647 from a textphone). When you get through I'll say "Good Evening, you're through to NHS Direct. My name's SSM and I'm a Health Advisor" The first thing I need to do is take your telephone number, and the address you're calling from. This is important in case we get cut off, or I need to send an ambulance. It seems impersonal, but it's necessary.
  • I'll ask for a brief summary of your problem, ensure the patient is visible to you, then take their name and date of birth.
  • I then have to ask five routine questions. This is necessary for every symptomatic call, so please do not bitch at me. These questions ensure the patient is conscious, that their airway, breathing and circulation are not compromised, and that the patient does not have a petechial rash that could indicate meningococcal septicaemia.
  • I will then ask questions more specific to the patient's symptoms.
  • These questions will enable the call to be given a priority (more on that soon). After I've accepted the priority (or upgraded/downgraded on the advice of a CS) I can complete the patient's chart
  • If there's an existing chart for that patient I can link them up, if not I'll create a new one. I'll confirm the address and phone number, ptient's ethnicity and gender, and GP details.
  • On the final screen I'll put in a call reason, the caller's name and relation to the patient, and a few notes.
  • I'll give an estimated callback time, but always advise that the caller should call back if the patient's condition changes or worsens.
OK, Priorities. Callers get very upset about this. Obviously if someone is in grave danger then they are a high priority call and need to be dealt with asap, but most people don't understand this at all. I'd say a good 70% of callers think that diarrhoea is more serious than a heart attack.

  • P1 - caller in immediate danger, with severe breathing difficulties, heavy bleeding, chest pain, threatening suicide, in labour, meningitis symptoms, ingested toxic substance and vomiting/in pain etc. - these calls are dealt with immediately/by the next available nurse
  • P2 - minor injuries, abdo. pain with diarrhoea and vomiting, fever, calf pain, mild chest/upper back pain, over 20wks pregnant with pain or bleeding, urinary problems, severe sore throat, heavy flu symptoms, swallowed toxic substance/foreign body but asymptomatic etc. - estimated callback within an hour, but in reality between 10 and 90 mins depending on how busy the service is.
  • P3 - cold symptoms, stubbed toe, mild headache, vomiting, complex meds query, 'man flu', pregnancy symptoms under 20 weeks, teething, nappy rash, hives, heat rash etc. - callback time is anything up to 4 hours, but can range between 30 minutes-6 hours if it's horrendously busy.
We also have D1, D2 and D3 - dental priorities:
  • D1 - sudden facial swelling, heavy bleeding, unable to breathe, severe facial injury (next available nurse)
  • D2 - Severe dental pain, pain relief tried and not working (within an hour)
  • D3 - pain for more than 2 weeks, pain relief not tried or giving relief of symptoms, loose fillings or crowns (the possibilities are infinite)

OK, explanations and 'When to use NHSD' in my next post, I'm exhausted from all the typing, I feel like I'm at work!

Stay tuned.

Posted by Sick Sad Minion at Friday, January 19, 2007 | | Comments

Wednesday, January 17, 2007

An Apology

People of Britain, I am apologising to you on behalf of all at NHS Direct, the NHS as a whole, and the UK Government. I am sorry we have robbed you of your coping skills, I apologise most humbly for destroying your critical thinking abilities, and wholeheartedly wish we could consign the last ten years to Room 101.

Yours, SSM.

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OK, seriously. What the fuck have we done to the people of Great Britain? My little, tiny multiple choice quiz will test your powers of reasoning.

1) Your toddler has a temperature of 37.2C. He has no symptoms, he does not feel unwell, he is playing, and chatting away. What should you do?

a) Open a window, make sure he's lightly dressed and drinking plenty of fluids
b) Monitor the situation, keep watch for any emerging symptoms as a raised temp. can often be a sign of underlying problems
c) Ensure your kid is wrapped from head-to-toe in woolly clothes and blankets, turn the heating up to full, then call NHS Direct. Scream and shout about meningitis, threaten to go to the papers because you're given a 20 minute callback time, then hang up and go to A&E


2) Your teenage daughter calls. She's been to your mum's house for tea with her grandparents. She's worried, Gran's had a chest infection for three weeks, but today her skin looks grey, and her lips and nose are blue. She seems to be struggling for breath. You live next door to them, what should you do?

a) Wait four hours and phone your own GP. Then phone your mum's GP. Then phone NHS Direct, complain that it's taken fifteen minutes to get through, ramble about your own granddaughter's recent measles scare, fail to answer questions directly, don't disclose that you live next door to your mother, then laugh when you're told the symptoms are very serious.
b) Go and see your mum immediately, confirm what your daughter has told you, and then call for help if necessary.
c) Dial 999

3) Your 4 year old has just come in from the garden, he's eaten a bit of mud after his big sister dared him to do it. He's upset, he trusted her and it was nasty! Oh my, what to do?

a) Comfort him, tell Big Sis to apologise and give him a cuddle, remember to tell all his future girlfriends about it.
b) Freak out. Strap the boy into his car-seat, phone NHS Direct on your way to A&E, scream "DO SOMETHING!" frequently, try and induce vomiting.
c) Keep an eye on the nipper, try and take his mind off it, these things happen, big sisters can be evil!

Now, these things seem like common knowledge to me. If your answers were 1C, 2A and 3B then I fear for you. These are all real examples from the last week at work. 1 and 3 actually happen every single shift.

Sorry Britain. We didn't mean to make you a nation of idiots, we were only trying to help. Can you forgive us?

Posted by Sick Sad Minion at Wednesday, January 17, 2007 | | Comments