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NHS Pathways system update - clinical release note - release 47.2.0

Release 47.2.0 was made available to suppliers and providers on 31 March 2025.

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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 47.2.0 are highlighted below. Release 47.2.0 was made available to suppliers and providers on 31st March 2025.

What we've changed

Alignment of ‘Resuscitation on the Field of Play’ guidelines within the appropriate pathways

Following stakeholder feedback and publication of new guidelines by the Resuscitation Council UK (RCUK), NHS Pathways have reviewed the appropriate pathways.

In agreement with the RCUK, changes have been made to improve triage and care advice for patients (both adults and children) who have collapsed suddenly during exercise/sport

The following changes were made
  • A new question ‘DID THE PATIENT COLLAPSE DURING SPORT OR EXERCISE?’ created for patients showing the symptoms: 'Unconscious but breathing adequately'; 'Fitting (current seizure activity)'.
  • Patients who answer ‘yes’ to the above question will receive a category 1 ambulance outcome along with Basic Life Support (BLS)/Automated External Defibrillator (AED) care advice, except for those with continuing seizure activity and a known history of epilepsy.

Amendments to the Adrenaline Auto Injector (AAI) triage

Following work completed in Release 45, a review of the national guidance and stakeholder feedback, NHS Pathways have made further 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.

Groups of patients that receive Category 1 ambulance outcomes also now includes
  • Patients between the age of 1 year and under 5 years with rapid airway swelling with functional impairment AND who are getting worse.
  • Patients over the age of 1 year with rapid airway swelling with functional impairment AND who are feeling faint.
  • Patients over the age of 1 year with rapid breathlessness and no rapid airway swelling.
  • Patients over the age of 1 year who are shocked with declared allergic reaction now, with or without a previously diagnosed allergic reaction, with rapid swelling of the tongue, throat or inside of the mouth.

Return of Spontaneous Circulation Assessment if patient is fighting for breath

Changes have been made to the assessment of Return of Spontaneous Circulation (the restoration of a normal heartbeat after a period of cardiac arrest), also referred to as ROSC, if the patient is fighting for breath.

The following changes were made
  • The question ‘HAS SUCCESSFUL RESUSCITATION AFTER CARDIAC OR RESPIRATORY ARREST BEEN DECLARED,’ is now also asked to people who are 'fighting for breath’. 
  • This will ensure that patients who are fighting for breath and answer ‘yes’ to the return of spontaneous circulation will receive a Category 1 ambulance outcome if they have not already reached a Category 1 outcome for other conditions.

Anaphylaxis care advice

Changes have been made to anaphylaxis (severe allergic reaction) care advice and the care advice given to those with bites and stings.

The following changes were made to anaphylaxis care advice
  • New anaphylaxis specific care advice has been created to align with national guidelines.
  • Guidance will be given to all patients reaching an ambulance outcome for anaphylaxis which includes information around positioning and breathlessness regardless of whether they answered ‘yes’ to breathing problems during triage. This ensures that evolving clinical conditions are managed appropriately and safely.
The following changes have been made to Bites and Stings
  • Patients with suspected bites and/or stings that have reached a Category 2 ambulance outcome for anaphylaxis will now receive adrenaline and new positioning advice. They are no longer advised to give antihistamines.

Change to Hepatitis Post-Exposure Prophylaxis (PEP) timescales

To align with the Green Book government guidance, NHS Pathways have made changes to the Hepatitis questioning.

The following changes were made
  • NHS Pathways have made changes to the Hepatitis B questioning to allow for the extended window to receive Hepatitis B Post-Exposure Prophylaxis (PEP) from 48 hours to 7 days.
  • The routes 'Sexual Concerns', 'Failed Contraception and Retained Condom or Cap' and 'Sexual or Menstrual Concerns' now contain the questions ‘Are you worried about possible HIV or hepatitis infection?’ and ‘If the concern is about hepatitis, was the risk of infection within the last 7 days?' to aid identification of those suitable for PEP.

Failed Contraception changes

Following changes made by NHS 111 Online, NHS Pathways have made amendments to the triage of failed contraception.

We made the following changes
  • Females aged over 16 years seeking to discuss failed contraception and/or to access emergency contraception previously were required to speak with an NHS Pathways clinician. Now, this assessment can safely be completed by a Health Advisor (HA).
  • Female patients aged 16-54 seeking emergency contraception will now reach a ‘Emergency Contraception required within 12 hours’ outcome if unprotected intercourse was within the last 120 hours (under 5 days). If longer than 5 days a primary care consultation within 24 hours outcome will be reached.
  • Those with sexual and menstrual concerns are now asked the question ‘When did you last have unprotected sex?’ to identify whether emergency contraception is suitable.

Extending the Primary Care outcome for Sore Throat and Hoarse Voice Pathway

As part of the primary care review to identify outcomes that can have their timeframes safely extended, NHS Pathways reviewed the assessment for sore throat or hoarse voice for patients 5 years and over.

We made the following changes
  • Patients who are not functionally impaired but have been more breathless within the last 6 hours (and have not had recent tonsillectomy or anaesthetic) will now be asked an additional question about confusion and if not confused will now be advised to contact a Primary Care Service within 6 hours’. Those who are confused will be advised to contact a Primary Care Service within 2 hours. 
  • Patients who answer ‘yes’ to the question ‘Have you got lots of blisters or ulcers inside the mouth?’ who previously reached a 6 hour primary care disposition will now be advised ‘To Contact a Primary Care Service within 12 hours’.

Consistency across the system for triaging patients stroke symptoms

NHS Pathways have made changes to the assessment for patients who have recently fitted and who are 16 years and over.

We made the following change
  • Patients who are 16 years and over and who are triaged by the ‘Recent Fits’ pathway and answer ‘not sure’ to the question about the onset of stroke symptoms ‘Did the symptoms start within the last 10 hours?' will now receive the same outcome as answering ‘yes’ and reach a Category 2 ambulance outcome.

Amendment to the Septicaemic Rash question wording and the ‘not sure’ triaging

Following the septicaemic rash (marks that look like bruising or bleeding under the skin) work completed previously, NHS Pathways have made further changes across the system.

To the question ‘Have you developed one or more new marks, like bruising or bleeding under the skin?’ for patients who are aged 5 years and above with a sore throat or hoarse voice, and the question ‘Does the rash look like blood spots or bruises under the skin?’ for patients with a skin rash, yellow skin or a suspected allergic reaction:

We made the following changes
  • Those who answer 'not sure' will now continue triage and will no longer receive an emergency ambulance outcome, unless there are other symptoms identified during the assessment which require an emergency ambulance outcome.

Removal of Septicaemic Rash assessment after identifying Acute Coronary Syndrome (ACS)

NHS Pathways have made changes to how patients who are 5 years of age or older with suspected Acute Coronary Syndrome (ACS) are assessed.

We made the following change
  • Septicaemic rash assessment (functional impairment with a specific rash) has been removed for patients where a Category 2 ambulance outcome will have already been reached for ACS or shock. This allows cardiac medication advice to be given where appropriate.

Toddler Eye Problems question amend

NHS Pathways have further reviewed the assessment for eyelid problems to improve identification of pre-septal cellulitis (infection within the eye lids) in toddlers.

We made the following change
  • Following a review, a new question has been created relating to eyelid problems. The question ‘Did the problem start IN THE LAST 48 HOURS?’ replaces a previous timescale of 24 hours to improve identification of the development of pre-septal cellulitis in patients between the age of 1 year and under 5 years.

Last edited: 21 March 2025 11:57 am