Introduction Delivering excellent healthcare in today’s NHS involves multiple agencies and depends on accurate communication between professionals in different locations. King’s College Hospital is a leading Hepatology centre that receives tertiary and quaternary referrals from across the UK and Europe. Frequently, the first point of contact with the Unit is via a telephone call to a Specialist Registrar, for whom no case notes are available in which to record information. Until recently, referrals were recorded on paper and filed in a secure office in the Department. We introduced an electronic database system to record a standardised dataset from each call in order to improve clinical governance and to generate contemporaneous records that could be easily retrieved and audited. We present our five-month pilot data.
Methods A Caldicott-compliant database was designed and made securely available to Registrars and Consultants. Registrars were encouraged to record all referrals and telephone calls they received. Calls taken by the Liver Intensive Care Unit, consultants, nurses, junior doctors and the out of hours team were excluded. Demographic and clinical data were recorded in real time with information regarding the source of the referral and the outcome of the call. There were no mandatory fields.
Results Data from 350 calls were entered over five months. The source of the call was recorded in 345 cases. 125 (36%) were from King’s College Hospital and 20 (6%) were from General Practitioners or patients. The remaining 200 calls came from 75 institutions. Of the 220 calls made from outside the Trust, 63 resulted in the patient being transferred (n = 32), reviewed as an out-patient (n = 27) or discussed at a multidisciplinary team meeting (n = 4) at King’s.
In 235 cases, discussion with a King’s Consultant was recorded (67%). Of the 115 calls where discussion with a Consultant was not recorded, 41 were from within King’s, 19 were transferred to King’s and in 36 cases there was continuing input by telephone advice from one of the teams at King’s. Only 15 extramural cases (7.5%) were concluded without a documented discussion with a Consultant.
Conclusion Use of an electronic database to record extramural telephone advice given by senior trainees and Consultants provides clinical governance to this service and forms a contemporaneous record that is kept at the referral centre. The data can be used to estimate workload and to determine the disease burden in this population, thereby tailoring services to the needs of referrers and commissioners. Formal recording of the Consultant input in the advice service also forms an excellent training opportunity for trainees. We recommend the implementation of similar databases in other units that give verbal advice to colleagues outside their own institution.
Disclosure of Interest None Declared.
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