Patients benefit profoundly when clinicians use immediate Advice & Guidance:
- Instant reassurance, avoidance of stress or worry.
- Avoidance of costs & disruption through unnecessary hospital visits.
- Right care, faster.
- Instant reassurance, avoidance of stress or worry.
- Avoidance of costs & disruption through unnecessary hospital visits.
- Right care, faster.
Real-life patient experiences are re-told by clinicians in our videos and in the examples grouped by hospital specialty below.
Telephone A&G – Elective Care
Telephone A&G – Mental Health
GP contacted the Acute Medicine consultant about a 27-year- old woman who presented with a one-week history of a flu-like illness with a dry cough, vomiting and left sided chest pain. The patient was noted to be pyrexial and tachycardic but had a normal sounding chest and normal O2 saturations. The GP suspected it was either a community acquired pneumonia or influenza and wanted to get an urgent CXR. The GP used immediate Phone Advice & Guidance to speak to a local Acute Medicine Consultant who “agreed that if the patient attended hospital, they would look at the CXR on PACS and call the patient with the results.”
The patient was prescribed antibiotics in case of pneumonia. “The CXR did not show any initial changes though the radiologist did report signs of possible pneumonia. Using Phone Advice & Guidance meant the patient was managed in the community avoiding the need for a hospital appointment.”
The Consultant’s Perspective:
“A young man had recently returned from holiday where he had experienced chest pains and had gone into the local hospital. Whilst there, he was diagnosed with Pericarditis.
The patient then saw his GP in England about two weeks later with ongoing symptoms. The GP wanted to know whether, at this stage, the fact that symptoms were ongoing was compatible with the diagnosis. I was able to reassure him that this was the case and that some simple outpatient tests and treatment for his in inflamed pericardium was appropriate.
The GP then informed me that the patient had taken cocaine. This changed the complexion of the case and I informed him that we needed to be certain that the symptoms were not due to a complication of cocaine which can cause heart attacks and through this an inflammation of the lining of the heart.”
“I advised the GP to refer the patient to the local cardiology department to be absolutely certain that the cocaine had not damaged the patient’s heart as this would clearly have implications for the future. The GP had already informed the patient about the dangers of cocaine use. In summary, therefore, I was able to help with the management of Pericarditis and at the same time advise appropriate evaluation to be certain that cocaine had not damaged this patient’s heart.”
The GP’s Perspective:
“I find the Consultant Connect App very convenient for getting quick advice when needed from specialist consultants – in this case Cardiology. I was put through very quickly and gained the information I needed to manage the patient effectively.”
“The patient felt put at ease that this was all done whilst he was in the room with me and he did not have to wait or come back. By speaking with the specialist directly in the presence of the patient, I felt that he was more involved directly in his care and decision process and felt comfortable that the advice we were giving was appropriate. From my point of view it felt like a more ‘connected’ approach without the divide between primary and secondary care.”
“A patient with heart failure complicated by a valve prolapse was under my care. Her management was delicate as she has co-existing renal failure that meant it was difficult to balance her diuretics and manage her polypharmacy. I contacted her cardiologist via Phone Advice & Guidance to get advice when she was unwell. I was able to establish what an acceptable renal function for her would be with the new diuretic regime, and also second-and third-line drugs to try next. Finally, the consultant gave me advice on when she would need admission. I was able to avoid admitting the patient, and she remained in her own home, whilst I adjusted her medication – which is what she wanted. Having a clear plan gave her reassurance and me confidence to manage her when she was more unwell.”
“A GP asking about atrial fibrillation, and general management” for a patient contacted the consultant. The GP did not feel that the patient “needed anticoagulation medication, at least until all the tests were in.” The consultant “informed him that the patient was at very high risk of having a stroke, and whatever the tests showed, they still needed anticoagulation drugs, and that the GP should consider starting today.”
“As the tests could easily take 3-4 months, this protected the patient against a possibly devastating stroke much earlier than originally planned” the consultant explained.”
This was “a good outcome and the GP was pleased with the advice.”
A GP used Phone Advice & Guidance to contact the consultant regarding a “75-year-old patient who had been taking clopidogrel and had a rash as a result.”
The GP was unsure whether the patient should be admitted to hospital. During the Phone Advice & Guidance call, the GP explained the history and situation of the patient.
As a result of the immediate conversation between the GP and the consultant, the patient “avoided a referral to the hospital.”
The Consultant’s Perspective:
“An elderly woman was last seen by her local cardiology team about 18 months ago with some narrowing of the the aortic valve. She went to see her GP as she was breathless. The GP found that she had fluid retention including swollen ankles and also discovered a heart rhythm disturbance which was atrial fibrillation. The first problem here is that atrial fibrillation in an elderly lady with heart problems creates a very high risk of blood clots in the heart, which can end up in the brain and cause a stroke. It is therefore very important to start powerful blood thinning drugs as soon as possible. The GP was aware of this but not certain of the interaction with the patient’s abdominal aortic aneurysm which could be life-threatening if it ruptured (particularly if the patient was on blood thinning therapy). I was able to reassure the GP that the benefit of blood thinners outweighed this risk and that this should be started today with a drug that would work immediately.
In addition, it seemed likely that her breathlessness was caused by a further narrowing of her aortic valve that had put pressure on the heart and resulted in the rhythm disturbance and inefficiency of the heart resulting in fluid retention. This is a condition known as heart failure and, when it is due to narrowing of the aortic valve, it is associated with a high early mortality risk. Accordingly, I was able to advise the GP that very early assessment by the local cardiology clinic was mandated. I suggested that she fax the local cardiology department requesting that the patient be seen within a week or 10 days to evaluate whether she was suitable for some form of operation on the aortic valve to relieve her symptoms and prolong life.”
“The patient benefited from a phone conversation with a consultant in two ways. Firstly, she was able to immediately start blood thinning treatment which protected her against a stroke. Secondly, the GP could use my name to access early local cardiology services and assessment for aortic valve surgery which, if possible, would dramatically improve symptoms and life expectancy. Without this phone conversation it is likely that the referral would have been through the standard route and could have taken many months during which time she would have been at risk of stroke and may have died from her narrowed aortic valve.”
The GP’s Perspective:
“I was very grateful to the consultant as he listened to my patient’s case with reassuring interest.”
“The consultant’s thorough advice was didactic and helped me a great deal in deciding a management plan and to expedite the referral to the anticoagulant clinic. I am supportive of Consultant Connect, it is a very useful tool.”
A GP saw a patient with a facial rash, which was presumed to be seborrheic dermatitis. As the patient wasn’t responding to standard treatment, the GP used the Consultant Connect App to take a clinical photo which was shared with the Dermatology Team at his local hospital. The advice was to try an alternative rosacea treatment. As a result of using Photo Advice & Guidance, the patient’s condition improved rapidly.
The patient was a child with an itchy body rash and a history of eczema. As the GP was “unsure if this rash was eczema or something else,” she used Photo Advice & Guidance via the Consultant Connect App to take clinical pictures of her patient. These pictures were shared immediately with the Dermatology Team at her local trust. As a result of sharing the pictures, the GP said: “I had a written response from a local consultant dermatologist the very next day. The consultant dermatologist diagnosed the rash to be chronic eczema with lichenification and follicular morphologies and wrote a detailed treatment plan for the patient.”
As a result of using Photo Advice & Guidance: “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.”
Diabetes and Endocrinology
“I was unsure if the patient should be started on insulin or oral hypoglycaemics. Usually I would manage Type II presentations myself, but admit children or teenagers presenting with Type I to Paediatrics. The patient was anxious to do something about the situation and wanted answers from me straight away. The Diabetes and Endocrinologist understood the difficulty, defining this type of Diabetes, and was able to start the patient’s management the same day through the Diabetes Nurses in the hospital clinic. Admission was never indicated, but a referral to outpatients would have taken some weeks at least. It felt good to have the management started within a few hours of the diagnosis. This was a great result.”
An 88-year-old patient was “found to be profoundly hyponatraemic (causing bradycardia and dizziness).” He had “recently undergone tests to investigate retinal artery occlusion.” Urea and Electrolyte results came back late from the lab. Using Consultant Connect’s Phone Advice & Guidance service, the GP was able to immediately contact a consultant at Queen Elizabeth University Hospital to discuss the follow up options. The patient was “seen at the Department for Medicine for the Elderly the following day where appropriate investigations were performed, and his medication was reviewed.” The GP says that “this avoided a late evening admission as [she] could discuss the patient’s current functional status with the consultant planning the follow up (which was very prompt).” As a result of using Phone Advice & Guidance, an “unnecessary admission” was avoided.”
A consultant received a call about an elderly patient, living on her own at home. She was known to have Chronic obstructive pulmonary disease, but had recently become more breathless. The patient complained of weight loss and a poor appetite and explained she had been collapsing at home. She had recently been seen in the Emergency Department, but they felt that she wasn’t improving.
“We arranged an urgent Outpatient Clinic appointment, which she attended. We were able to assess her, with access to her medical records and previous investigations. Blood tests, an ECG and lying and standing Blood Pressure were checked and advice with regards to changes to her medication was given. We were able to liaise with other services involved in her care.
This enabled the patient to get the assessment and support she needed without an emergency admission.”
“Recently, during a weekend shift, I attended an elderly male who was in severe pain due to a large swelling in his groin. Through hearing the patient’s past medical history and my examination, I was concerned that he was suffering from a strangulated hernia. Our current guidelines require us to take all surgical cases with the exception of Abdominal Aortic Aneurysm to Perth Royal Infirmary in the first instance for assessment. I used Phone Advice & Guidance to raise my concerns that it would be detrimental to my patient to have him taken to Perth Royal Infirmary for assessment only then to be transferred on to Ninewells Hospital for the immediate attention his condition required.
Through my immediate discussion with the senior consultant at Ninewells Hospital, we agreed to bypass Perth Royal Infirmary and transfer my patient directly to Ninewells Hospital which helped to speed up his treatment.”
A paramedic used Phone Advice & Guidance to speak to an A&E consultant about a patient experiencing what had “the potential of a stroke mimic.” The paramedic thought the patient was experiencing Bell’s palsy. Using Phone Advice & Guidance allowed him to speak to an A&E consultant who was able to talk him through a few simple steps to confirm his suspected diagnosis. Immediate Phone Advice & Guidance gave both the paramedic and the A&E Consultant the confidence that the best pathway for the patient would be to be referred to their local GP rather than needing to undertake a journey to hospital.
“The patient was happy that the outcome meant a local appointment with their GP as opposed to an 80-mile round trip to hospital.”
“A patient had on-going problems following amoebic dysentery abroad, protracted diarrhoea despite treatment and negative stool cultures. I was sure he didn’t need an urgent scope, but not sure whether steroids should be used, or if I should refer him in. The consultant suggested the use of a further course of metronidazole and refer in if still having problems.
Both myself and the patient felt reassured that he could get access quickly to a consultant opinion.”
A patient presented “with obvious inflammatory bowel disease.” It was not clear what the best course of action was, and the GP was unsure whether to start the patient on steroids. He used immediate Phone Advice & Guidance (via Consultant Connect) to speak to a gastroenterologist from his local hospital. The gastroenterologist provided advice and recommended commencing the patient on steroids in addition to an urgent outpatient clinic referral. This avoided an acute admission – a much better result for the patient. Both the patient and the GP were satisfied by the use of Phone Advice & Guidance.
“My patient was facing delay to a complex gynae surgery decision. This was because the consultant was off work long term. The patient was very anxious the delay would make surgery harder and less likely to be successful. She had been ‘primed’ with a hormonal injection and anticipated a scan to assess changes and to help plan surgery. The gynaecologist understood the situation was complex and time critical and needed to make a speedy clinical assessment in the absence of the colleague. They offered to get the patient re-assessed on the 2-week pathway. The patient was relieved by this and It felt better that the responsibility was lifted off me.”
“A 54-year-old female presented with obvious advanced cancer. The two-week wait (2WW) referral had been done. I tried ringing 2WW but because this line is not staffed by a clinician, I was unable to move the appointment from 14 days and the patient was deteriorating. When using Phone Advice & Guidance, I was put through to one of the gynaecologists within seconds and they arranged for the patient to be scanned that day and given appropriate follow-up treatment. This would have been an acute admission otherwise. An acute admission was avoided, and the patient was given the care they needed.”
“A 35-year-old patient presented with inter-menstrual bleeding and post coital bleeding. She had a inter uterine device in-situ and had had a recent normal smear. I examined the cervix and took some swabs: both were normal. I was able to quickly speak to a gynaecologist and discuss my findings. The gynaecologist advised that at this stage I had done all that was needed and all that they would do. The most likely cause was irritation from the IUD threads. I agreed with the patient that she would return for a follow-up appointment if she had additional symptoms or a progression of her symptoms. The patient (and I) were reassured and a referral to clinic was avoided.”
A GP used Phone Advice & Guidance to contact a consultant on the National Consultant Network about a patient as they were unsure “which investigations or whether a referral was needed for a patient with a long history of non-specific body pain and a slightly raised kappa light chain level. During the conversation, the consultant explained “that a normal haemoglobin, creatinine and the very slight increase in kappa light chains, in the setting of a normal serum protein electrophoresis meant that this did not warrant a referral.” Instead the consultant advised the GP to “check the patient’s calcium level for completeness and check the serum free light chains in 12 months.”
“One of my patients is an 88-year-old who suffers with Trigeminal Neuralgia and takes Carbamazepine. A few weeks ago, the patient collapsed and attended A&E. They found that the patient had low sodium levels and recommended to stop Carbamazepine. After being discharged, the patient’s pain returned and could not be controlled with Opioid Analgesia. This affected the patient’s mood and quality of life. In spite of stopping Carbamazepine for six weeks, the patient’s sodium levels were still low. The patient was then diagnosed with SIADH in their urine and had a plasma osmolality test.”
The GP suspected that the cause of SIADH was the Carbamazepine.
“I used Consultant Connect to get specialist phone advice about alternative medication to Carbamazepine for my patient. I was connected to a neurologist from outside of our area. He was extremely helpful and informed me that, normally sodium levels improve within 2-4 weeks of a patient stopping Carbamazepine. As the patient’s sodium levels had not improved in that time, the neurologist did not think that the Carbamazepine was what caused their SIADH. So, he suggested referring the patient to an endocrinologist for further investigation.
He also recommended trying Carbamazepine again or Phenytoin as another option. However, he advised me that the side effects for an 88-year-old could be high but that it was also worth a try.
Following a discussion with the patient and their family, we agreed the patient would try Phenytoin. However, the patient had to stop the medication after two weeks due to side effects. With the neurologist’s advice, I felt confident enough to stop Phenytoin and try Carbamazepine again. The patient’s symptoms improved within two weeks, there was no deterioration in their sodium levels and they was subsequently reviewed by an endocrinologist.”
Older Adult / Working Age Adult Mental Health
“I was discussing Consultant Connect with one of my colleagues, a consultant psychiatrist, and he explained that he’d been called one day by a GP who was in a meeting with a patient, and that GP was able to put the consultant psychiatrist onto speakerphone, and they were able to have a three-way conversation about the person’s mental health problems, so it was like having an additional specialist in the room to call on for that ten minute appointment with the GP.”
“I had a patient the other day who came in who needed some medication change in terms of depression. She’d just been started on some antidepressants, she had been breastfeeding and then had experienced some side effects. I wasn’t quite sure about exactly what I should be changing – like going up with the medications, or whether I should actually be looking at changing medications. So I used the app and got directly through to one of my colleagues here at Oxleas, one of the psychiatrists, who was able to give me some really quick advice over the phone. The up-side of that was it gave the mother a lot of confidence that I was able to access expertise in a really quick way.”
“We had a GP who rang us, who was concerned about the fact that somebody was using the A&E as a kind of frontline service, and not going to their GP. They had anxiety, and so when they became overwhelmed they would go to A&E. What I talked through with the GP was how the GP might be able to develop strategies to enable that person to come to him and for him to be able to reassure her that he was going to be able to manage her mental health needs, whilst stopping her from taking up valuable resources in A&E. So I talked with him about things like medication, about groups in the community that might help, and I also spoke to the mental health professional involved who increased their visits, and then we were able to help that person reduce or stop their visits to A&E, with the GP being the main source of management for that person.”
“I answered a Phone Advice & Guidance call about a baby that had difficulty feeding. The mother had taken the baby several times to see the GP, the baby was growing alright and the GP wasn’t too worried but the GP had a distressed mum and baby. He was thinking about what they might be able to do to help, unsure if they really needed to do something different, but feeling that they probably should do something different. We were able to have a conversation around whether there were other symptoms there and that information guided me to think the baby probably had cows milk protein intolerance. So rather than just being a crying colicky baby, it probably had a milk intolerance and we were able to suggest some milk changes and a referral, but in the interim the GP had something they could go back and offer to the mum. So, without that peripheral information that I asked, we probably wouldn’t have thought to offer that solution to that mum before they came in. Hopefully our conversation and my advice will have reduced the distress for the baby.”
“I saw a baby who was relatively well. He had a slight cold but the mother was worried. The examination was largely uninformative apart from an oxygen saturation of 82%. I tried different oxymeters but the sats were still low.
I decided to discuss my findings with a paediatrician who immediately told me to send the child in! The child ended up in hospital for four days and was treating for the infection on site. The point is, apart from the low sats, the baby was as good as normal. Using Phone Advice & Guidance that day was crucial. If I hadn’t had the conversation with the specialist, it’s very likely that the baby would have ended up as a 999 all from home later.”
“I spoke to a Rheumatology Consultant at my local Trust. The consultant reviewed the blood results and confirmed a likely diagnosis of Rheumatoid Arthritis and advised they would most likely give Depomedrone injection and then consider DMARD. Speaking to the consultant made me feel confident to continue to support the patient and his wife, and meant they knew what was likely to happen. They had a chance to read preparatory patient information so could make an informed decision regarding starting a DMARD in that first outpatient appointment. It was easy to get through, and a few minutes on the phone meant that we could work in an integrated way across primary and secondary care. Together we were able to deliver good quality care to this vulnerable patient.”
“I saw an elderly gentleman with symptoms suggestive of Polymyalgia Rheumatica, however it was an atypical presentation and I was concerned that I might be missing something (such as underlying cancer) and was not sure whether to initiate treatment or wait for further tests or refer, knowing that a referral could take several weeks. I called the Rheumatology team via the Consultant Connect App and was able to discuss the case in detail with the senior registrar who advised me what tests to organise and when to initiate treatment, as well as a detailed steroid reducing regime. The registrar explained all the things that would have been arranged at the first clinic appointment, so I was able to get the ball rolling before the patient would be able to be seen at the clinic. This was a better outcome for the patient who was able to get the right treatment quickly.”
A patient presented to the GP with symptoms suggesting Giant Cell Arteritis. The GP was able to use immediate Phone Advice & Guidance on the Consultant Connect App to speak to a local Rheumatologist at Poole Hospital NHS Foundation Trust. The consultant advised on the best course of action. The GP commented that he “can highly recommend” using this service.
Speaking to a consultant was “an excellent, direct, and time-saving way to access timely consultant advice.” Using the app is “the easiest way to speak to a specialist consultant [the GP has] yet to find.” The GP also explained that he called Rheumatology again a week later. This “ensured that the patient had a timely clinic review to consider a temporal artery biopsy.” This was a positive result as Phone Advice & Guidance allowed the patient to get quick and effective care.
A patient was concerned he “might have developed changes to a skin cancer incision scar but examination revealed no concerning features.” The GP used PhotoSAF on the Consultant Connect App to take a photo of the patient and later downloaded it so that it could be “reviewed at intervals.” When the scar was reviewed at intervals, the photos “evidenced no change.” The GP was pleased with the use of PhotoSAF as it saved the patient “further anxiety.” He also highlighted that a secondary care referral was avoided – saving time for both the patient and local consultants.
A patient presented with skin lesions that needed to be “reviewed over a period of time to see if there were any changes.” The GP could securely photograph the lesions with PhotoSAF and was later able to download and save them to the patient’s medical record. The photos were compared to the lesions at a later date and it was clear that they had “remained unchanged.” The GP explained that using PhotoSAF meant that a “referral was avoided.”
Another patient also had lesions but was, in this case, housebound. The patient did not want to be referred to hospital but the GP felt that the lesions may be cancerous and so she “wanted advice.” She took a picture using PhotoSAF and, upon downloading it from the secure cloud to her computer, was able to forward it to a dermatology consultant at RUH. The consultant reviewed the image and agreed that it was likely to be a form of cancer. The patient was assured that a referral was necessary and “agreed to be seen by a consultant.” This ensured that the patient got the necessary medical care.
“A patient was advised to see me by another health professional who had noticed a change in one of the patient’s moles. I would have referred the patient to a dermatology clinic had it not been for A&G – possibly even on the fast-track suspected cancer pathway. Not only did this Advice & Guidance service give me the confidence to seek advice, but once I had received a reply from a dermatologist, it also gave me the confidence to reassure my patient. This avoided further anxiety for my patient as well as a referral.”
“A consultant dermatologist replied by e-RS to the image I sent saying “the attached photos are of super quality (thank you).” The dermatologist was able to comment of macroscopic and dermatoscopic features (as I had held my phone’s camera directly over a dermatoscope for one of the images) and to state that the lesion looked benign. The dermatologist suggested for a GP to see the patient again in four months to compare the mole with the images taken via PhotoSAF.”
A patient who was under a nurse’s care was suffering from a leg ulcer which was taking a very long time to heal. The patient “felt that the wound was not healing at all at some points.” They had become “very low in mood as the wound was also malodourous.” By taking photos of the condition, “the patient’s progress was tracked.”
The nurse explained that “the patient’s wound has now healed.” However, before this, she was able to monitor her patient’s condition (over time). The pictures also allowed the patient to “see the progress even if it was slow.” Using PhotoSAF on the Consultant Connect App in this way really benefitted the patient as the nurse said it “improved her mental health.” She also explained that using PhotoSAF, “allowed a detailed handover to her team member for holiday cover.”
“I suspected a patient was developing Peripheral Vascular Disease but wasn’t sure. Measurements at the surgery had been done and were suspicious so I wanted to order further investigations but wasn’t sure which or if admission was needed. I went on the app and contacted the vascular surgical team who suggested that they would do all the investigations in a one stop shop vascular clinic as needed so admission wasn’t necessary unless things got worse and a routine clinic referral was made. The patient avoided unnecessary admission and investigation and had a more convenient one stop shop review which confirmed the diagnosis. The patient was very glad to not have to be admitted to hospital.”
For more information about how we work with commissioners, hospitals & mental health trusts to improve patient care, please get in touch.
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