The Red Flag | Patient Safety must be built into OLC

The red flag has many connotations; socialist revolution, a sign of irritation (red rag to a bull), a Hindu celebration of auspicious occasions, but the biggest red flag warning is that of danger.

Online consultations are now part of how patients access healthcare

The use of online consultations has taken off during COVID-19 and is offering many potential benefits both to clinicians and patients. It has enabled GP practices to remain open and continue to provide a high level of care for their patients throughout various lockdowns. In the vast majority of cases, this has been without the need to visit the surgery, reducing the risk of infection and helping to keep both patients and staff safe.

Online consultations have also ensured patients have been seen based on their clinical need, they have helped improve access to practices, driven efficiency gains and enabled remote working for clinical staff, particularly important when they have been self-isolating.

However, like any clinical practice, there are inherent risks. The clinician has a moral and professional duty to act in an ethical way; non-maleficence and beneficence sitting at the heart of every clinician’s thought process. Without actually seeing the patient it can be hard to gauge their clinical acuity, and the best online consultation platforms understand this challenge and mitigate the risk through robust algorithms, red flags and clinical governance.

A detailed clinical history is what allows accurate triage

We are taught as clinicians that a full, detailed history, especially in the patient’s own words, can contribute up to 85% of the diagnostic decision-making process. Without a good history take, it is very difficult to ascertain what is going on with the patient and therefore much harder to safely manage their condition. Often, histories are taken over the phone by duty doctors, which is fine, but offers its own challenges too – 40-50 callbacks per day, often the patients don’t pick up, and when busy, the history take may be incomplete.

This is where a safe and robust online consultation platform can add value. By taking a full, and complete history from the patient in their own words (including their own ideas, concerns and expectations) in a structured way without any missed questions or answers, it means that the doctor has enough rich information at their finger-tips to make a quick and safe management decision. If they need to see the patient, they bring them in or enlist a video consultation function. If they need more information, they can call them, otherwise many can be managed safely and remotely, without further conversation.

The keywords here are robust and safe. With the proliferation of online digital offers during the pandemic, there are now many platforms that offer a ‘quick and easy’ route for patients to access their GPs through completion of a free text box. This is incredibly convenient for the patients, but also staggeringly dangerous.

If that free text information submitted by the patient sits within the practice’s inbox for a number of hours, even days in some cases, without any prior emergency screening, the outcomes for the patient could be serious and life-threatening. If the clinician does pick up the information, the chances are they will have to call the patient back and take a further detailed history, negating the potential benefits of the online consultation in the first place.

eConsult is built with this patient safety at our core

At eConsult Health, we are a company led by doctors, and as such safety is at the heart of everything we do. Our eConsult patients have submitted over 10 million online consultations to date, and we are fast building expertise in this field.

We would never allow free text boxes to be submitted on their own without asking the other necessary questions. Not only have we built intelligent algorithms with over 10,000 clinical sets using our in house team of clinicians, but we have also developed the most sophisticated and comprehensive governance and red flagging processes in the industry.

There’s a reason for this: to both keep our patients safe and to protect our clinical users, so that they have the necessary information to enable a safe decision.

We have red flags that signal dangerous symptoms and automatically signpost patients to more immediate and appropriate care for their condition, e.g. diverting to A&E or to Urgent Care. We have flags that alert the clinicians to potential signs and symptoms that may require more timely intervention, and we have flags that pick up symptom clusters that signify potential early detection of disease, e.g. cancer early warning signs, enabling safe and rapid routing to different investigative and treatment pathways.

Safety and governance are at the heart of everything we do, and there’s a reason why we never take shortcuts.

Red flags signify danger.

Red flags should be built into every online consultation platform. That’s the least we can do for our patients.

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Written by:

Dr Mark Harmon, BSC (Hons) | Strategy and Brand Director at eConsult Health.

Mark qualified from King’s College School of Medicine in 2014 and has since worked in a wide range of Specialties across Primary and Secondary care. Prior to studying medicine, Mark held some senior strategic and brand executive positions in some of the world’s leading blue-chip companies, such as Nike, Speedo, The Arcadia Group and Marks and Spencer plc. Mark joined eConsult Health in 2016.