We spoke with Drs Giri and Jo Russell, GPs in Bassetlaw and Solihull, respectively. We wanted to find out how their use of the Haematology Advice & Guidance lines benefited them and their patients.
Dr Giri has had access to Telephone Advice & Guidance provided by Consultant Connect since 2017, and prior to this would seek advice by ringing the on-call team or admitting the patient directly.
‘Consultant Connect is a useful and effective alternative because I’m able to contact the consultant in the particular specialty I need and can receive better quality advice.’
Dr Russell, who looks after a cohort of frailty and elderly patients in local nursing homes, agreed that she would also refer the patient to hospital if specialist advice was needed.
‘It’s difficult to put across the frailties of a patient in a letter that may not be read by a senior clinician. Telephone Advice & Guidance allows me to deliver more patient-centred care, as my frail, elderly patients in nursing homes require a slightly different approach when deciding which investigations and treatments are appropriate. When considering the possibility of not sticking to an agreed and accepted protocol, it is safer to discuss the individual case with a colleague.’
‘It is a good service to avail especially when one is not sure and also for more complex patients.’
– Dr Giri.
‘Referral of frail elderly patients to hospital is almost always complicated because of their comorbidities and sometimes not in the best interest of the patient. Telephone Advice & Guidance gives me immediate access to a senior specialist colleague and a rapid outcome and patient management plan. This is of huge benefit to these patients.’
‘I was the on-call doctor one day and received abnormal blood results for one of my patients who had leukaemia and was under the care of a haematologist. The patient was undergoing chemotherapy, but the blood result indicated a sudden drop in haemoglobin and platelets.
I used Telephone Advice & Guidance via Consultant Connect to contact Haematology and luckily was able to speak to the patient’s consultant. As she knew the patient already and could see the results, she immediately took over the patient’s care, contacting them and managing them going forward.
Had I not used Telephone Advice & Guidance, I would have had to admit the patient through the Emergency Care Unit (EMU) or Acute Medical Unit (AMU) which would have meant an increased wait for the patient and going through inappropriate services.’
‘I saw a frail 85-year-old patient in a nursing home with a history of schizophrenia and dementia, who had developed abnormalities in their full blood count. In a younger patient, I would have referred urgently via rapid access but, given the patient’s comorbidities, I wanted to know what investigations would be considered and how invasive they might be.
After calling Haematology Advice & Guidance via Consultant Connect, the haematologist reviewed the results and explained that the blood picture looked like Chronic Lymphocytic Leukaemia (CLL). He felt that a bone marrow biopsy would be the investigation of choice but that it might be too traumatic for the patient. We decided that, after discussions about the patient’s current physical health, investigations were not in their best interest. The CLL was likely to be very slow to escalate and, since the patient has a very stable quality of life, it was perfectly reasonable not to investigate further.
This reassured me that I had really considered the pros and cons of whether to investigate or not. The haematologist was so helpful, we avoided a referral, and the patient maintained their quality of life. It enabled me to be part of the decision-making process, and this was important given the patient’s health.’
For clinicians unsure about using the service, the doctors advised everyone with access to give it a try.
‘The consultants are lovely and really supportive. My concerns have been taken very seriously and my questions answered. I have never been made to feel like I’ve wasted anyone’s time.’