Unscheduled care - professional to professional decision support: guidance

Design

Effective professional to professional decision support should be designed taking into account local structures and existing referral and communication pathways. Communication between clinicians should advocate best practice, be supportive in nature and be captured in the patient record.

Below are the key considerations when designing and implementing a professional to professional decision support approach:

Workforce

• Access to an appropriate Senior Clinical Decision Maker during evidenced key hours. This clinician should have the experience, knowledge and skills to provide remote clinical decision support and access to the required patient records and information
• Ideally the Senior Clinical Decision Maker should not be undertaking other direct clinical duties whilst providing professional to professional decision support, particularly during evidenced key hours and for high call volume specialties such as acute medicine, acute surgery and emergency medicine. However professional to professional decision support could be provided in association with other remote / virtual consultation work, for example within Flow Navigation Centre operations. Individual health boards should develop the workforce model that works best for them

Systems, Processes and Data

• The Senior Clinical Decision Maker should be easily accessible. The service should be well publicised with clear guidance on hours of operation and scope of practice
• The necessary supporting infrastructure is in place to enable effective clinical communication
• Ability to record and subsequently access calls to support good clinical governance
• Ability to electronically capture data in relation to calls received, missed calls and outcomes
• Ability to respond to calls in real time, within an agreed timeframe (local standard / key performance indicator [KPI]) and fall back processes for unanswered calls should this not be met, as part of local board processes
• Agreed structured handover and conversation tool e.g. SBAR (Appendix B) and the use of 'read back' (it is important that the receiver of the information reads back a summary of the information and any shared decisions, also using the agreed structured handover and conversation tool format)
• Patient consent, the handover and agreed shared decisions / patient plan should be recorded within the patient management systems (patient record) using a structured format
• All records should be stored in line with current records management policies for the organisations

Health Boards may consider procurement of products which support professional to professional communication approaches by providing an infrastructure to deliver the service in line with governance and data requirements. Health Boards who use such products report advantages such as:

• Ease of set up, ease of scale up, single number multi-specialty and minimal training required
• Immediate post call access to the call recording
• Ability to securely store recorded calls over a period of time
• Ability to easily access and interrogate call data including:
  • Call volumes and timing
  • Source of calls
  • Call duration
  • Call outcomes
• This data can be utilised to inform management of workforce and service gaps, and identify pathway opportunities
• Specialist platform support