Unscheduled care - professional to professional decision support: guidance

Appendix D: Patient Case Study Examples

Example 1: NHS Greater Glasgow and Clyde (Primary Care)

Patient:

Female / Aged 55 years

History:

Patient had experienced 6 weeks of persistent vomiting and feeling unwell. Patient taking methotrexate for Rheumatoid Arthritis. Recurrent contacts with GP (phone and face to face). Bloods had persistently shown raised white cells and lymphocytosis, low albumin and raised Alkaline Phosphatase

Situation:

Deterioration in condition and consideration of admission

Response:

Use of Consultant Connect to link with the Acute Consultant on call. Discussion held regarding case and agreement made to see the patient the following day to have imaging undertaken

Results:

Patient diagnosed with Crohns disease with hospital admission avoided by prioritising the Professional to Professional discussion and also having the facility to see the patient ("hot clinic") the next day, alongside easy access to CT scan

Example 2: NHS Lanarkshire (Cardiology)

Patient:

Female / Aged 62 years

History:

Patient presented to their GP with intermittent palpitations in the context of known Atrial Fibrillation. This had been occurring for a long period of time despite various attempts to reduce symptoms with different medications

Situation:

Patient was becoming increasingly frustrated about the symptoms and was starting to develop associated symptoms of shortness of breath when exerting herself

Response:

The patient's GP would have previously considered an unscheduled care referral to an acute site due to tachycardia and failed attempts to control with medications. However GP utilised Consultant Connect to obtain professional to professional advice from a Consultant Cardiologist at University Hospital Hairmyres

Results:

The Consultant Cardiologist was able to look at previous telemetry, out-patient echocardiogram images and recent community blood results, providing advice with regards to change in medications. Both decided that the patient would be suitable for catheter ablation and the patient was added to the ablation waiting list at the point of discussion