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Abstract
Aims To evaluate uptake, timing and usefulness of a new Paediatric telephone advice clinic at a busy District General Hospital.
Local GPs currently have only two choices when referring for a paediatric opinion- same day A&E assessment or 8 week wait for outpatient review. We surveyed the existing referrals system and asked local GPs on options to improve primary-secondary care communication.
Using those results we developed a new telephone advice service. Following an online referral GPs are allocated a next working day timed slot, when they are contacted by the attending Consultant Paediatrician. There are two daily appointments available Monday-Friday. Local CCG agreed to fund the advice service on a trial basis from April 2015.
Methods After 6 months of the service we retrospectively reviewed all referrals received. Timings of referral to consultation were noted. A paediatric SpR reviewed all outcomes and assessed whether an OPD referral had been avoided.
Results Previous surveys identified that 16% of phone calls to the on-call team were for advice only. 21% of OPD referrals could have been alternatively managed. 28/30 local GPs asked for access to consultant-led telephone advice.
63 referrals were received in six months (average 2 /week). This represented a low uptake with only 21% of the available appointments slots used. One (8%) of these met the target for next day consultation (Figure 1).
37 referrals (59%) were managed in primary care after advice and no further referral made to secondary care (Figure 2). Only nine (14%) telephone consultations led to Paediatric OPD referral and one (8%) led to a same day ED referral.
Time from receipt of referral to allocated telephone advice appointment. Average time was 4 working days
Referral outcome of telephone-based consultation
Conclusion The telephone advice clinic fills a gap requested by local GPs to improve the interface between primary and secondary care. Based on the current uptake rate it has the potential to prevent over 70 OPD referrals a year, a 10% reduction in annual referral rate.
However, the service has not yet met the target of next working day advice. There is also scope to improve take-up by GPs as only 21% of available slots were utilised in this first 6 months.