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.