Unscheduled care - professional to professional decision support: guidance

This best practice guidance will help effective clinical communication and support shared decision making, with the aim of accessing alternatives to hospital attendance or admission where appropriate and safe to do so.

Appendix C: Local Framework Example

NHS Tayside professional to professional services support an innovative multi-front door model which enables direct access to services such as Acute Medicine, COVID Assessment, Cardiology and Stroke; supporting delivery of providing early definitive care for patients and supporting the aim of care from the right person, in the right place, first time. This also allows their Emergency Departments to provide timely patient care, which is reflected in sustained performance against unscheduled care targets, and no identified issues with ambulance "stacking".

Their existing framework means that it was possible to rapidly establish a dedicated professional to professional advice line for the COVID Assessment Unit, which was launched on the 13th March 2020. This dedicated unit directly accepts patients with known or suspected COVID-19 and provides rapid assessment, alternatives to admission or admission to the specialist 'hospital within a hospital'. This ensures that the 'assess to admit' principle successfully applied in other unscheduled care areas is equally embedded in the Tayside COVID model.

Since September 2018, professional to professional services have been supported by Consultant Connect enabling call recording and effective activity analysis. Over 50,000 calls have been handled through the system in Tayside.

Professional to professional advice is available to Primary Care in and Out of Hours, Scottish Ambulance Service, NHS 24 and regional services such as Minor Injury Units and prison health services via a dedicated telephone line. This ensures senior clinical decision maker advice early in the patient journey.

Data analysis of these services over the last 10 years consistently shows the efficacy of this approach. Even more so since the introduction of the COVID Assessment Unit in March 2020 and the establishment of a local Flow Navigation Centre as part of the RUC programme in December 2020 including:

  • Consistent 30% alternative to hosptial attendance in calls from the Scottish Ambulance Service
  • 30% reduction in acute inter hospital transfers
  • 35-40% of NHS 24 Direct Referrals to Flow Navigation Centre result in "non ED attendance"
  • Only 20% of patients receiving a 4 hour call back from the Flow Navigation Centre require an unscheduled attendance at the Emergency Department
  • During "wave 2" 30% of patients discussed with the COVID Assessment Unit did not attend hospital

Through promoting availability of professional to professional services, uptake and use of the service has significantly increased during the COVID pandemic. During this time outcomes of calls including accessing care outside the hospital environment in 30% of cases were maintained, significantly increasing the number of patients accessing early community care and avoiding unnecessary hospital attendance. These pre-hospital remote consultations have also resulted in a significant decrease in inter hospital transfer between their two acute sites.



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