Safety recommendation
HSIB recommends that NHS Digital reviews the supporting information for triaging the breathless child up to 16 years of age, to determine whether there are features of life-threatening breathing difficulty.
Response:
Thank you for the opportunity to be involved in this investigation and for raising this safety recommendation with NHS Digital.
NHS Pathways (on behalf of NHS Digital) is a telephone and digital triage Clinical Decision Support System (CDSS) that has been in use since 2005 within the Urgent and Emergency care setting. It is used in all NHS 111 services and half of English ambulance services. This triage system supports the remote assessment of over 19 million calls per annum. Calls using NHS Pathways are managed by non-clinical specially trained ‘Health Advisors’ who refer the patient into suitable services based on the patient’s health needs at the time of the call. The Health Advisors are supported by clinicians who can provide advice and guidance or who can take over the call if the situation requires it.
NHS Pathways continuously reviews and refines the pathways and questions to ensure it is up to date and learning from feedback. NHS Pathways has undertaken a review of the question relating to breathlessness in children under 16 years old and agreed to make changes to the supporting information for those aged 5-11 years old, to include chest recession (an indrawing of the chest which may indicate breathing difficulties). Chest recession is already included in the supporting information for children under 5 and it was not considered appropriate to make this change in 12-16 years old (as per national guidance). Changes made were in line with guidance from National Institute for Health and Care Excellence and have been approved by The Royal College of Paediatrics and Child Health. The changes were made to Release 26.2.0 of NHS Pathways which was deployed on 21st April 2021.
ACTIONS: Review of question relating to breathlessness for children under 16 years old, specifically to consider adding a prompt for chest recession in the supporting information.
TIMELINE: Complete. Review undertaken and changes made to supporting information of breathlessness question in those aged 5-11 years old to include chest recession.
Changes effective in NHS Pathways Release 26.2.0 which was deployed on 21st April 2021.
Response received on 26 July 2021.