Quelles solutions pour la garde en médecine générale? - KCE
Quelles solutions pour la garde en médecine générale? - KCE
Quelles solutions pour la garde en médecine générale? - KCE
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108<br />
Items<br />
providers will move straight to face e to face assessm<strong>en</strong>ts.<br />
The call handdler’s<br />
first step will be e to ask for the pati<strong>en</strong>nt’s<br />
demographic detaails<br />
such as name, address,<br />
date of birth ettc.<br />
The call handler wwill<br />
input these into thee<br />
IT<br />
system to seaarch<br />
for any previous records for this pati<strong>en</strong>nt<br />
or to create a new reecord<br />
if this is the pati<strong>en</strong>t’s<br />
first contact withh<br />
the service. This seaarch<br />
will also id<strong>en</strong>tify if f the<br />
pati<strong>en</strong>t’s GP has provided the serv vice with any informattion<br />
(called special paati<strong>en</strong>t<br />
notes) re<strong>la</strong>ting too<br />
the pati<strong>en</strong>t’s conditioon.<br />
At this stage the ccall<br />
hander will also trry<br />
to<br />
id<strong>en</strong>tify whethher<br />
the condition of th he pati<strong>en</strong>t is of an immmediately<br />
life threat<strong>en</strong>ing<br />
nature and if so, tthe<br />
call will be transfeerred<br />
to the emerg<strong>en</strong>ccy<br />
services along with the<br />
demographicc<br />
information.<br />
After taking ddemographic<br />
details and<br />
transferring any lifee<br />
threat<strong>en</strong>ing calls thee<br />
call handler will ask a number of questionns<br />
about the pati<strong>en</strong>t’s condition/symptoms. TThe<br />
degree to whhich<br />
these questions are<br />
based on an algoritthm<br />
or proscriptive proocess<br />
will vary dep<strong>en</strong>dding<br />
on the organization<br />
but all providers arre<br />
likely to have somee<br />
set<br />
questions to id<strong>en</strong>tify common urg<strong>en</strong>t<br />
conditions.<br />
The specific qquestions<br />
asked will dep<strong>en</strong>d d on the caller’ss<br />
description of the pati<strong>en</strong>t’s<br />
symptoms. Thee<br />
aim of this stage is tto<br />
id<strong>en</strong>tify the urg<strong>en</strong>cyy<br />
of the call rather than<br />
to<br />
take a full history<br />
or make a diag gnosis. At the <strong>en</strong>d of<br />
this stage the call handler will have <strong>en</strong>ttered<br />
notes on the system<br />
about the symmptoms<br />
described by the<br />
caller/pati<strong>en</strong>t focusing on the mos st important details, aand<br />
will have prioritiseed<br />
the call as either eemerg<strong>en</strong>cy,<br />
urg<strong>en</strong>t orr<br />
less urg<strong>en</strong>t/routine.TThe<br />
emerg<strong>en</strong>cy calls are<br />
passed to 999.<br />
Telephone addvice/telephone<br />
consu ultation<br />
Consultationss<br />
For pati<strong>en</strong>ts wwho<br />
walk into a prima ary care c<strong>en</strong>tre rather than telephoning the sservice,<br />
the intake will<br />
usually be undertake<strong>en</strong><br />
by a receptionist assking<br />
simi<strong>la</strong>r questions<br />
to<br />
call handlers or giving the pati<strong>en</strong>t a form to fill in.<br />
A minority of after-hours organizations<br />
have implem<strong>en</strong>teed<br />
a further process foor<br />
some calls, usuallyy<br />
referred to as ‘call sttreaming’.<br />
For example<br />
as most childr<strong>en</strong> unnder<br />
the age of fivve<br />
will require a face-to-face<br />
assessm<strong>en</strong>t, ssome<br />
services bypasss<br />
triage and the call hhandler<br />
arranges an aappointm<strong>en</strong>t<br />
at the prrimary<br />
care c<strong>en</strong>tre for the<br />
pati<strong>en</strong>t. As thhis<br />
type of process is outside o the national quality<br />
requirem<strong>en</strong>ts, wwhich<br />
assume that all ccalls<br />
should receive cclinical<br />
assessm<strong>en</strong>t, it is important that serviices<br />
agree this variation<br />
with the commissioning<br />
primary caree<br />
trust (PCT). They alsso<br />
need to be able repport<br />
on the numbers annd<br />
waiting times for these<br />
pati<strong>en</strong>ts separateely.<br />
Home visits<br />
Staff involvedd:<br />
Affter-Hours<br />
Primaary<br />
Care<br />
Results<br />
<strong>KCE</strong> Reportss<br />
171<br />
Call handlerss:<br />
Are g<strong>en</strong>erallyy<br />
responsible for the first<br />
stage of the process<br />
with their duties priimarily<br />
consisting of answering<br />
calls, taking pati<strong>en</strong>t details, inputtting<br />
these into the system<br />
and prioritisinng<br />
calls based on symptoms<br />
as described bby<br />
the caller.<br />
Receptionistss:<br />
Are responsibble<br />
for receiving pati<strong>en</strong> nts at primary care c<strong>en</strong>tres<br />
and will also connduct<br />
the first stage foor<br />
walk-in pati<strong>en</strong>ts whoo<br />
arrive without telephooning<br />
the service first. .<br />
Duty manageers:<br />
Are responsibble<br />
for running the call<br />
c<strong>en</strong>tres or c<strong>en</strong>tral huubs<br />
where calls are answered<br />
and where trriage<br />
is oft<strong>en</strong> located. They manage call haandlers,<br />
receptionists and<br />
dispatchers.<br />
Dispatchers:<br />
Are normally located at the call ce <strong>en</strong>tre/hub and are responsible<br />
for assigningg<br />
home visit calls to ddiffer<strong>en</strong>t<br />
mobile cliniciaans<br />
in cars. They may<br />
also be responsiblee<br />
for<br />
assigning triaage<br />
calls to clinicians and a booking base visit<br />
appointm<strong>en</strong>ts. Somee<br />
organizations managge<br />
all of their visits c<strong>en</strong>trally<br />
using dispatcheers<br />
to determine to whhich<br />
mobile clinician<br />
a home visit should<br />
be assigned and to call pati<strong>en</strong>ts to book base visit appointm<strong>en</strong>nts.<br />
Others will managge<br />
calls by locality, e.gg.<br />
s<strong>en</strong>ding all home visits<br />
for an area too<br />
a particu<strong>la</strong>r mobile clinician<br />
in a car, reduccing<br />
the demands on cc<strong>en</strong>tral<br />
dispatching.<br />
G<strong>en</strong>eral pracctitioners<br />
(GPs):<br />
For most afteer-hours<br />
organizations s the majority of clinicaal<br />
staff working in the service will be GPs. TThey<br />
may work for thee<br />
service full-time but most do shifts on a ppart-
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