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NHS Pathways system update - clinical release note - release 45.2.0

Release 45.2.0 was made available to suppliers and providers on 7 October 2024.

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NHS Pathways make changes to content based on new or emerging clinical evidence, change requests, and feedback from our providers or wider stakeholders. 

NHS Pathways identifies areas of content that would benefit from enhancement. The aim of these enhancements is to provide clarity for users, and to benefit both users’ and patients’ experiences, thus ensuring that triage is as safe, effective, and efficient as possible. 

The enhancements to Main Telephony made by NHS Pathways for Release 45.2.0 are highlighted below. Release 45.2.0 was made available to suppliers and providers on 7 October 2024.

What we've changed

Cauda Equina amendment to the screening question and disposition

NHS Pathways were required to make changes to the existing triage for patients with suspected Cauda Equina Syndrome (CES), which is a nerve root compression that causes pain, weakness and incontinence, to ensure it is in line with the NHSE Getting It Right First Time (GIRFT) guidance.

The following changes were made
  • In pathways where cauda equina is considered, new questions have been added to establish whether back or leg pain is present. If back or leg pain is identified then further questions asking about symptoms of possible cauda equina are asked. Questions aiming to identify specific symptoms of cauda equina syndrome have all been updated and also now establish whether symptoms have started or got worse in the last 2 weeks. Patients who can make their own way to an Emergency Treatment Centre will now get a ‘Refer to Treatment Centre within 1 hour’ outcome, instead of a ‘Emergency Ambulance Response (Category 3)’ outcome.

Use of Adrenaline Auto Injector (AAI) to align with the guidance for schools

Following review of the national guidance and stakeholder feedback NHS Pathways have made changes to the system to ensure there is the appropriate guidance for schools to support use of a spare AAI (Adrenaline Auto Injector) to be given in the case of a life-threatening emergency.

The following changes were made
  • 3 new questions have been added to the system to support the use of a spare AAI in a school setting.
  • New care advice will now be given when an AAI is required in a school setting to advise schools to follow their policy for the administration of the AAI.
  • To assist patients to correctly identity whether they have a AAI available and the type of injection the supporting information has been amended to include brand names.

Stroke symptoms update to the dispositions for children

Following external feedback NHS Pathways were required to make changes to how children presenting with stroke-like symptoms are triaged.

The following changes were made
  • Children aged 5 to 16 currently presenting with stroke-like symptoms, whose symptoms began within the last 4/10 hours will now receive an ‘Emergency Ambulance Response for Possible Stroke Time Critical (Category 2)’ outcome in line with adults. Previously the outcome for this age group was an ‘Emergency Ambulance Response (Category 3).

Tracheostomy, updates to the care advice

Following internal review, NHS Pathways were required to make changes to care advice for non-ventilated tracheostomy patients (a tube is inserted through the opening and into the windpipe to help the patient breathe).

The following changes were made
  • For non-ventilated patients: If an inner tube is present untrained callers will now get instructions to remove the inner tube if removal of loose caps/covers or other visible objects hasn’t already resulted in improvement. As previously, only those who are trained in using a suction machine are advised to use suction (new question to specifically ask if trained to use a suction machine replaces previous general question that asked if trained to manage blockages).
  • The ‘Tracheostomy/Laryngectomy, caps or covers’ care advice has had the word ‘loose’ removed when referencing caps or covers.
  • The ‘Tracheostomy/Laryngectomy, foreign body’ care advice has been amended and now refers to objects that are blocking the neck tube.

Mental Health Professional calls

Following external stakeholder feedback, NHS Pathways were required to make changes to the options that present for a Mental Health professional.

The following changes were made
  • Mental Health professional callers will now be asked the question ‘Is there a threat to life, limb or sight requiring immediate emergency admission?’ to identify if there are any signs of a time critical medical event.

Skin Lumps and Fever

Following external feedback, NHS Pathways were required to make changes to the Skin, Lumps pathway for specific cohorts of patients.

The following changes were made
  • To reduce cognitive load the question ‘Have you been diagnosed with a condition where an infection might be very serious?’ has been amended and now reads ‘Have you been told that getting an infection might be very serious?’.
  • If answered ‘yes’ the Supporting Information now includes a reference to genetic conditions. This is a system wide change.
  • Those with fever and lumps on any part of the body who are very unwell or have gotten worse in the last 24 hours will now reach a Contact a Primary Care Service within 12 hours outcome.

Assessment of a potential Aortic Aneurysm

Following stakeholder feedback, NHS Pathways were required to make changes to the assessment of a possible aortic aneurysm in the Critical Illness pathway.

The following changes were made
  • Patients over 60 years of age who are identified as having either severe pain or who are functionally impaired with worsening pain are now asked the question ‘Have you been diagnosed with an aortic aneurysm?’. This means that those who answer positively to the main problem being constipation or a urine problem will no longer bypass the question about previous diagnosis of aortic aneurysm.

Care Advice for Labour Updates

Following external feedback, NHS Pathways were required to make changes to the care advice given in the Labour and Childbirth pathways for 1st party labour.

The following changes were made
  • For 1st party calls with imminent labour a new question has been created ‘Is there someone with you who can follow instructions?’ to identify whether there is another person present to assess whether the baby is visible.
  • Where an appropriate 3rd party is identified, triage looks to establish which part of the baby can be seen and provide more specific care advice which was unavailable in the 1st party pathway.

Question wording amended for identification of fever or infection cause

Following stakeholder feedback, NHS Pathways were required to improve clarity when identifying the possible cause of a fever or infection.

The following changes were made
  • The question identifying whether the patient has had an operation or dental procedure in the last 2 weeks has had injection included and now reads ‘Have you had an operation, dental procedure or injection IN THE LAST 2 WEEKS?’.
  • The Supporting Information has been updated to include ‘Botox’ and ‘fillers’ as examples of a needle or surgical instrument being inserted into the skin.

Last edited: 4 October 2024 4:31 pm