We’ve used a selection of our patient case studies to highlight how Advice & Guidance is part of the central NHS landscape and is already playing a significant part in helping to increase capacity and resilience whilst accelerating recovery ahead of winter.
1. More patients are avoiding a trip to hospital
Remote consultation using patient photos
- “The patient was provided with the correct treatment plan early on. They did not need to wait for a dermatology hospital appointment – a potential hospital referral was avoided.” Read the case study.
Specialist input during GP consultation
- A patient with coeliac disease was suffering from a rash that her GP thought was dermatitis herpetiformis. After using Advice & Guidance to contact a specialist, the GP was able to call the patient back within 5 minutes to confirm the correct diagnosis and the best management plan. Read the case study.
Acute attendances/ admissions avoided
- A patient with a swollen leg had previously presented to the Emergency Department. The symptoms persisted and the GP used the Consultant Connect App to contact the Acute GP Unit Medical Admissions team. Read the case study.
- “I contacted the Acute Medicine consultant about a 27-year- old patient. I suspected it was either a community acquired pneumonia or influenza and wanted to get an urgent CXR.” Read the case study.
- “Given the degree of anaemia, I wondered if she might need admission for a transfusion. Using Consultant Connect I rang for advice, and she was able to advise that iron tablets should be sufficient even with a haemoglobin of 7, as it would likely increase the level by 1g per week, and the patient was relatively asymptomatic and not keen for admission. We also discussed treatment the patient had tried for Menorrhagia previously and we developed an alternative management plan.” Read the case study.
2. More elderly people are being treated in the community or are avoiding an admission
- “I saw an elderly 80-year-old patient who was waiting for a hip replacement. The operation was cancelled by the anaesthetist because the patient’s sodium level was low, and they were slightly anaemic. I used Telephone Advice & Guidance, via Consultant Connect, to speak to an elderly care consultant. Being able to get this type of advice quickly improved the care of the patient. Without the service, it may have taken three months for them to see a consultant, and by that time, the patient could have been presenting with new clinical conditions.” Read the case study.
- “An elderly patient had recently been discharged following ten days in hospital due to a cerebrovascular accident. Given their history, mobility, gait issues, and the fact they lived at home with their elderly wife, who was also frail, the carer was uncomfortable managing the situation. The situation could not be escalated without an assessment from an Occupational Therapist (OT).” Read the case study.
- A late evening admission was avoided as [the GP] could discuss the patient’s current functional status with the consultant planning the follow up (which was very prompt). Read the case study.
- “Having access to a multi-disciplinary team who can best assess the patient’s needs not only helps us keep patients in their own home but also enables health and care partners to perhaps intervene at an early stage and provide proactive care or advice.” Read the case study.
3. More NHS areas will use advice and guidance for other settings/services
Same Day Emergency Care
“A recent example is that of young taxi driver who was seen by his GP with a ten-day history of intermittent chest pains. The GP used Consultant Connect to call the SDEC line and was advised that the patient should be referred that same day to the SDEC unit. The patient was seen rapidly, given immediate treatment on suspicion for unstable angina and was referred to the cardiology team before any diagnostic tests had even been reported. With the specialist input from SDEC, and then the direct referral to cardiology, the patient underwent invasive coronary angiogram the same day which demonstrated right coronary artery disease and that he needed two stents put in. By referral through Consultant Connect the patient received the correct advice and management plan within four hours.” Read the case study.
- “If the Scottish Ambulance Service (SAS) or Police Scotland are attending a patient’s home and need advice about the patient’s mental health issues, they can contact the Mental Health Assessment Unit (MHAU) to discuss and agree a plan for the MHAU either to attend the patient’s home or SAS/Police Scotland can bring the patient directly to the MHAU for a mental health assessment rather than attending the ED which was the pathway pre COVID-19.” Read the case study.
GPs helping 111 operators
- “Without Telephone Advice & Guidance, I think the patient would have been taken to A&E with the potential of being exposed to Coronavirus.” Read the case study.
Community services getting rapid specialist input
- Community eye services use Consultant Connect to contact specialist Ophthalmologists: “It’s particularly helpful during COVID where our usual referral pathways have been disrupted.” Read the case study.
Paramedics having access to local Trust specialists
- “The patient was happy that an 80-mile round trip to hospital was avoided.” Read the case study.
- Following Scottish Ambulance Service guidance on COVID-19, the patient did not fall into the at risk of deterioration category and there were no red flags identified. As the patient was only suffering from mild symptoms, she was deemed to be suitable to remain at home.” Read the case study.
- Paramedic, CSD and Operations teams within Ambulance Trusts across the UK are using the A&G service to contact specialists. Read the article with case studies.
Specialist Mental Health Medication advice for UK GPs
- “A GP contacted me about the management of a complex psychotropic medication regimen and akathisia in a young man with antisocial personality disorder, anxiety and depression.” Read the case study.
- “The patient was taking sertraline but wanted to switch back to mirtazapine. The reason for this was that it helped the patient to sleep better but the GP was unsure how to handle switching the medication.” Read the case study.