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NHS Pathways is a clinical tool used for assessing, triaging and directing the public to urgent and emergency care services.
About NHS Pathways
NHS Pathways telephone triage system is a clinical decision support system (CDSS) supporting the remote assessment of callers to urgent and emergency services. It is used in the following settings:
- NHS 111
- Integrated Urgent Care Clinical Assessment Services
- NHS 111 Online
- To assist in the management of patients presenting to urgent care or emergency departments (Reception Point)
The system is owned by the Department for Health and Social Care, commissioned by NHSx and delivered by NHS Digital.
Services commissioned by NHS England and host system suppliers enter into licences with the Secretary of State for Health and Social Care, allowing them to embed NHS Pathways within their products.
The system is maintained by a group of experienced staff most with an urgent and emergency care background. All of the clinical authoring team are registered, licensed practitioners.
How it works
The system is an interlinked series of algorithms, or pathways, that link clinical questions and care advice, leading to clinical endpoints. Non-clinical call handlers are presented with a series of questions. Based on the answers given, the most appropriate clinical response with a specific level of care and the time frame, is reached.
Questions are asked in a clinical hierarchy, so life-threatening questions are asked early in the call, progressing through to questions about less urgent symptoms.
The NHS Pathways system is broadly divided into three modules with the system taking a symptom-based approach, rather than a diagnostic one.
Module 0 consists of the entry pathways into the NHS Pathways system. Emergency situations are dealt with by asking questions about:
- commonly occurring “declared” serious conditions, such as heart attack, stroke, anaphylaxis or blood sugar problems (evidence shows that for certain high profile or well understood conditions, callers often declare these and are correct in their assumptions, so the system provides a rapid means of assessing such urgent cases).
If the answers given to the symptoms assessed in Module 0 are sufficiently serious, the questions will trigger the dispatch of an emergency ambulance. No further questions or considerations of conditions are needed at this point.
Module 0 rules out some, but not all, life-threatening conditions. Once these have been ruled out, the call handler reaches Module 1.
Module 1 starts with a body map – a pictorial representation of a human body relevant to the age and gender of the patient - and contains all of the questions that may be asked by a call handler. Pathways related to that body area or body system are available and selected determined by the caller’s report of the main or worst symptom. Where there is no single main or worst symptom, the non-clinical call handler should seek clinical advice.
The system will then present various questions to the non-clinical call handler. Each answer will determine the next question asked until:
- an end point (disposition) is reached
- the call is ended early
- the call is handed to a clinician
The questions continue in a hierarchical order, and so generally the more questions asked, the less severe the symptoms.
Module 2 is only accessible to trained in-house clinicians. The module allows, if required, validation of calls that have been previously assessed by non-clinical call handlers, and for further assessment when a call becomes too complex for a non-clinical call handler to safely triage. This is an essential risk management tool.
Training and continuous quality improvement (CQI)
NHS Pathways provide an extensive, high quality portfolio of training resources to enable end users to train call handlers in the safe and effective use of the system. Delivery of Accredited Trainers’ Module is undertaken by the NHS Pathways team, working closely with end users using a rigorous quality assurance process that ensures all site trainers are delivering to a consistently high standard.
All call handlers and in-house clinicians must complete training and pass assessments to a set level before they can use the system in a live environment. Once they start taking live calls, all users must complete further assessments before they can practice independently.
Every member of staff using NHS Pathways has a certain number of their live calls audited, with more frequent audits for staff that:
- are inexperienced
- work infrequently
- fail to maintain mandated basic minimum standards
CQI activity is enhanced with the provision of call levelling sessions, where calls are peer reviewed during a facilitated session between call handlers.
NHS Pathways also provides performance related data for end users to use through the Intelligent Data Tool (IDT). Analysis of this provides the ability to look at:
- call length
- referral patterns
- rates of calls transferred to a clinician
- other factors in respect of individual call handlers
This information can generate important markers related to an individual’s practice and performance.
Clinical safety and governance
NHS Pathways welcome end user feedback to help improve the system.
Clinical content requests for change and issues received by end users into the NHS Pathways clinical issues log are given a priority grade.
This captures details of any:
- requests for change
- suggestions for enhancements
- serious incidents
- near misses
- referrals to a coroner relevant to NHS Pathways
- details of the processes for requests for change and the management of feedback and issues raised within the NHS Pathways log, and a summary of the last period’s entries
- monthly 999 and 111 performance management data reports
- clinical release notes detailing the system enhancements and updates to NHS Pathways’ content in each release
- You Said/We Did documents confirming the high level changes made within each NHS Pathways release
Why and how we process your data within the NHS Pathways service, and your rights.