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Primary Care

Clinical triage is essential to any safe online consultation platform

Riccardo Garavani  | 9th December 2021

Would you drive a car without seatbelts or an airbag? I don’t think most people would. These are safety features that you hope won’t be necessary, but are there in case something goes wrong. 

At eConsult, we take clinical safety extremely seriously.

  • We want patients with urgent and emergency conditions who seek help online to be redirected to appropriate services for their own safety.
  • We don’t believe that patients always know how significant or serious their symptoms are, that’s why we triage, just like clinicians do.
  • Patients operate in a complex healthcare ecosystem under pressure. There are important factors that influence patients’ behaviour when seeking advice. eConsult allows them to voice their concerns and expectations, and if they need urgent assessment, we advise and support them to seek help elsewhere.
  • When patients have safely submitted an online consultation, we give them an expected response date and time from the practice.

eConsult is one of the only digital triage providers for the NHS that gives you a structured patient history but also triages out those patients who need to be assessed without delay. It’s this thoroughness alongside our clinical expertise that means you can confidently manage your patients remotely.

Our triage system is built into the platform with the sole purpose of intercepting clinically urgent symptoms. We make sure to clearly advise patients about what symptoms require urgent care and how to access that outside of eConsult. 

Although we continually gather feedback from patients and clinicians to improve the message of our warning screens, we also know that blanket disclaimers aren’t enough. We can’t assume that patients know what is and isn’t critically urgent. We hope critically ill patients don’t use eConsult, but we know they will. So our safety nets are there for those moments when you might not realise something is as serious as it is. 

At eConsult, our clinical expertise is founded on

  • The experience of our team, comprising 11 primary and emergency care clinicians.
  • Our external panel of NHS consultants and practitioners from relevant specialties.
  • A track record of delivering over 20 million online consultations.
  • A robust clinical governance process where we investigate all clinical incidents.
  • Responsive feedback channels from clinicians, patients and commissioners.

This builds a continuous cycle for the active improvement of our product.

These are the safety features built into our platform:

  • Urgent and Emergency redirections, for when patients present with concerning symptoms that can’t be safely assessed online and need prompt assessment, either directly back to the practice, via 111 or if an emergency then direct to 999 or A&E. 
  • Two levels of flagging on the eConsult report, to highlight key patient responses to your clinicians.
  • eConsult-developed templates based on structured question sets, allowing us to adapt the questions asked based on previous responses and to stratify patient risk.
  • Limited free text answers, allowing patients to express concerns and expectations in their own words, just as they would in a typical face to face consultation in primary care.
  • Some language recognition tools to catch important information in free text answers (for example thoughts of self-harm).
  • Validated scoring systems for example all the mental health pathways include a PHQ-9 and a GAD-7 questionnaire, assessing the severity of symptoms of depression and anxiety.

These clinically designed questions do the same thing as an airbag for online consultations. 

They’ve been designed by clinicians from across the NHS to:

  • Ensure that patients who are not suitable for the online consultation route are diverted.
  • Ensure that patients who complete the online consultation do so safely.
  • For those patients that safely complete and submit an online consultation, any priority patients are highlighted to practice staff. 

Over the last decade of digital triage, we’ve developed 10,000 question sets to serve patients’ needs. They are there to ensure that no patient comes to harm.

Emergency and Urgent redirections navigate patients to the right care based on their answers

Emergency redirections

On the rare occasion that a patient gives an answer that suggests they might have an emergency condition (for example symptoms suggesting they are having a heart attack or a stroke) the system will bring up a message signposting them to either call 999 or go to their local Emergency Department.

Another example of an Emergency redirection is patients going down the Headache pathway answering that they have had a sudden, severe headache like being hit on the head. This raises the concern about a possible subarachnoid haemorrhage.

Urgent redirections

If a patient’s answer suggests that they should have a real-time clinical assessment that day, either by calling the practice or 111, the system will bring up a message advising them to do just that. In these situations, it’s important that patients are assessed without delay.

It is a constant balance to ensure our urgent warnings are identifying all the patients who need more urgent assistance while making sure we are not over-flagging patients who could be safely and effectively managed via the online route.

A special case: patients expressing thoughts of self-harm

Thoughts of self-harm are not uncommon, and not just in patients with mental health conditions. That’s why we’ve developed a considered pathway to support such patients doing an online consultation. For those expressing not just thoughts, but also showing intention and having made plans, they will see a different message advising them what to do next. 

Helping practices to prioritise and triage patients who submit eConsults: Two levels of flagging

Over 90% of patients manage to successfully complete and submit an online consultation without being redirected. These are consultations that are of a suitable level of risk that the practice can review, triage and respond (not necessarily resolve!) by the end of the next working day. However, it is important that practices have in place safe and robust procedures to handle and prioritise incoming eConsult reports and how they do this will vary greatly from one practice to another. 

The key thing is for the practice to understand the advantages and limitations of digital consultations and have in place systems to mitigate any clinical risk that might arise, just as they would for incoming telephone requests. As part of the onboarding process, we support practices to establish workflows to ensure they regularly monitor and review incoming eConsult reports from their patients. Whilst reports mainly come in via email or flow directly into the clinical system, we’re also working on an exciting new feature that will give practices much better visibility of incoming eConsults and support them in their triage process.

In the patient reports that reach the practice, we’ve designed a number of ways to draw attention to important information to help practices triage incoming requests. There are two kinds of flags on the reports, shown next to the patient’s answers:

  • Red flag icons highlight responses needing urgent attention, for example, possible cancer flags which may require a 2-week referral.
  • Amber exclamation mark icons warn clinicians that this answer may require close attention.

This information is clearly signposted on the GP eConsult report as well as in the file name and email subject line.

There is a balance between being too risk-averse and not including urgent warnings. Our Clinical Governance and Development teams continuously review our eConsult platform to respond to feedback, improve our content and maintain clinical safety. As a company, we are working hard to improve the user experience, while maintaining patient safety. We constantly monitor and tweak our content to ensure we get the right balance.

What next?

Want to find out more about how our structured question taking allows for safe triage? Or, want to speak to our team? Book in a call with us.