Can Remote Healthcare Really Work?

John Willock, 43, made a series of calls to the NHS telephone helpline after becoming ill after falling on ice on Christmas Eve 2009.

He had hurt his knee, was "fluish", cold, shivery and feeling sick - but hid his vomiting and diarrhoea symptoms from his partner and family until Boxing Day because he did not want to spoil their Christmas.

In one recording played to the fatal accident inquiry into his death, training engineer Mr Willock pleaded: "Is there anything anyone could suggest or is there anything I can get for it? I cannot move. I am bed-ridden because of the diarrhoea."

When Mr Willock rang for a second time the day before he died, call handler Ann McDermid failed to pass on to a nurse that he had called before.

A recorded telephone conversation showed she said to the nurse: "The patient's got burnin' sensation" and "he's got a burning sensation in his chest for about 10 hours" and "an aw the other symptoms, OK?"

Nurse Fiona McCulloch, who took over the call, ticked the wrong boxes on her computer diagnostic screen.

If she had ticked the one marked "persistent abdominal upper abdominal discomfort" an emergency ambulance would have been sent for Mr Willock.

She told him to take Gaviscon and cold milk, later admitting that this was inappropriate for someone suffering from sickness and diarrhoea.

Another NHS 24 call handler, Carolyn Fergie, admitted at the inquiry she was "tired" when she took Mr Willock's third call to the helpline.

She confessed to being "abrupt", rushing the call and failing to listen to what Mr Willock was telling her.

She failed to record on the system that Mr Willock was a "return caller" and that his condition was "serious and urgent"

As a result, nurse Pamela Scally treated it as a first call and advised Mr Willock to contact his GP practice within 36 hours.

His condition deteriorated on 29 December - without ever having been admitted to hospital - and he died at home at tea-time that night after his partner Carolann Rogers dialled 999.

The view of a leading infectious diseases expert, who said he believed Mr Willock had a survival chance of between 60% and 85% if he had been seen in hospital on 27 December, the day after he had admitted he was ill.

Then amazingly:

He was visited at home on the day he died by his own GP, Dr Murray Macpherson, who decided the patient was not ill enough for hospital.

However, Sheriff Pettigrew said he could find no "reasonable precautions" that may have prevented Mr Willock's death. He said: "There was insufficient evidence led before me to conclude that, even if a GP had visited Mr Willock (prior to the visit of Dr Macpherson) and given him an anti-emetic injection and arranged his admission to hospital, there was a 'real and lively possibility' that... would in any event have made a difference.

So was Mr Willock's death preventable or not - two opposing views in the report?

Whilst they admit that there were serious failings that need to be addressed (the usual line that gets trotted out when something as serious as this happens), does this show that remote healthcare is not all that it's supposed to be? Had Mr Willock gone to A&E instead, would it have improved his chances as, I'm sure, he would have been very pale and probably clammy which could have been a visual clue to the nature of his condition?

I know it's cheaper to have systems like this - not sure that Mr Willock would agree that it is a justifiable saving of money though.

http://www.bbc.co.uk/news/uk-scotland-24456142

Re: Can Remote Healthcare Really Work?

There was a programme about 'remote health care' on radio 4 not long ago .
The call handlers refer to a flow chart , I have something similar in an old medical book which is ok for the mildest of symptoms but pretty useless if someone is really ill.

Instead of wasting money on all these silly 'initiatives' it would be far better to get back to having a doctor on call in every local surgery. This should also ease the pressure on our overworked A&E departments.

...there will always be slip ups but I still think access to a Dr is preferable to some call handler who has no knowledge of a patient attempting to assess them on the other end of a phone line.

Re: Can Remote Healthcare Really Work?

BIB: I couldnt agree more.

Re: Can Remote Healthcare Really Work?

I'm very wary of this, my own experience was first time I went into anaphylactic shock, I could ring as I was having problems breathing so my husband rang. Gave my details and symptoms, they said take me to the GP, so he did where they said take me to hospital. Half way there my heart stopped and he rang 999 straight away. Ambulance/paramedic was with us in seconds luckily we were close to their base. They were shocked we had been given the advice we had as any allergic reaction as serious as mine should have been attended by ambulance from home.

It was a both the remote service and our GP surgery that let us down that day.

So it can go wrong even if you are seen by a GP.

Re: Can Remote Healthcare Really Work?

This stood out in that report straight away.....

quote....'after becoming ill after falling on ice on Christmas Eve 2009.

He had hurt his knee, was "fluish", cold, shivery and feeling sick - but hid his vomiting and diarrhoea symptoms from his partner and family until Boxing Day because he did not want to spoil their Christmas.'...unquote...

And also this..

quote...'Nurse Fiona McCulloch, who took over the call, ticked the wrong boxes on her computer diagnostic screen.

If she had ticked the one marked "persistent abdominal upper abdominal discomfort" an emergency ambulance would have been sent for Mr Willock

Obviously there were failings here on both sides, the unfortunate man himself 'hiding' his symptoms, and two days of vomiting and diarrhoea??

If he had sought help earlier and if the nurse had ticked the right boxes?....who knows what the outcome would have been.

And although I risk of the wrath of the cynical...
111 works well in our county and our Doctor's surgery still does house calls.

Re: Can Remote Healthcare Really Work?

I'm sure if he'd realised what those symptoms signified, he wouldn't have kept quiet but I think most of us would try to hide feeling unwell on Christmas Day so that we didn't end up spoiling it for everyone else so I don't think he can be blamed really - I certainly wouldn't connect falling over with being potentially fatal in that way. I still think that if he had been seen earlier by a competent doctor, he may still be alive.

That's it - I'm moving to your area