NHS Pathways is a triage software utilised by the
National Health Service
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
of
England
England is a country that is part of the United Kingdom. It shares land borders with Wales to its west and Scotland to its north. The Irish Sea lies northwest and the Celtic Sea to the southwest. It is separated from continental Europe b ...
to triage public telephone calls for medical care and
emergency medical services
Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
– such as
999 999 or triple nine most often refers to:
* 999 (emergency telephone number), a telephone number for the emergency services in several countries
* 999 (number), an integer
* AD 999, a year
* 999 BC, a year
Books
* ''999'' (anthology) or ''999: ...
or 111 calls – in some
NHS trust
An NHS trust is an organisational unit within the National Health Services of England and Wales, generally serving either a geographical area or a specialised function (such as an ambulance service). In any particular location there may be several ...
s and five of the
ambulance services
An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport.
Ambulances are used to respond to medi ...
in the country.
In its emergency capacity, it has replaced the
Advanced Medical Priority Dispatch System
The Medical Priority Dispatch System (MPDS), sometimes referred to as the Advanced Medical Priority Dispatch System (AMPDS) is a unified system used to dispatch appropriate aid to medical emergencies including systematized caller interrogation and ...
for some trusts, and in non-emergency telephone triage it is found in many medical care triage systems, such as
NHS 111
111 is a free-to-call single non-emergency number medical helpline operating in England, Scotland and parts of Wales. The 111 phone service has replaced the various non-geographic 0845 rate numbers and is part of each country's National Health S ...
.
The system, born from a desire to reduce unnecessary call-outs for emergency services, and to reduce the instances of patients rebounding between care providers due to repeated re-triage, is designed to triage any health problem and refer to the appropriate service either within or without the service undertaking the triage. With an attached Capacity Management System, NHS Pathways is designed to factor in what services are available local to the patient when supplying care provision. In essence, the intention is that any health care problem can be triaged by any arm of the NHS – emergency or non-emergency – and can be directed to any possible health care provider without the need for a second triage on referral, or any delay.
Mechanism of triage
As with many triage systems, NHS Pathways operates on a
diagnosis of exclusion
A diagnosis of exclusion or by exclusion (''per exclusionem'') is a diagnosis of a medical condition reached by a process of elimination, which may be necessary if presence cannot be established with complete confidence from history, examination or ...
, excluding conditions based on a set of triage questions developed by senior clinicians at
NHS Digital
NHS Digital is the trading name of the Health and Social Care Information Centre, which is the national provider of information, data and IT systems for commissioners, analysts and clinicians in health and social care in England, particularly th ...
. Upon arriving at an illness or injury that cannot be excluded, the system directs the patient to the appropriate level of care for that condition. Theoretically, patients will receive a higher level of care than their actual condition warrants on occasion, but should never receive a lower level.
Unlike previous triage systems, in an emergency capacity NHS Pathways can lead the patient to doctor, nurse, emergency department, or home-care advice dispositions, whereas previous systems often merely led to various levels of ambulance response.
The lack of such care providers in an area also highlights gaps in services for the NHS to review.
Current usage
NHS Pathways is currently utilised in eight of the eleven English ambulance services:
*
North East Ambulance Service
The North East Ambulance Service NHS Foundation Trust (NEAS) is an NHS foundation trust responsible for providing NHS ambulance services in North East England. Headquartered in Newcastle upon Tyne, NEAS provides emergency medical services to th ...
999 and 111
*
South East Coast Ambulance Service
The South East Coast Ambulance Service NHS Foundation Trust (SECAmb) is the NHS ambulance services trust for south-eastern England, covering Kent (including Medway), Surrey, West Sussex and East Sussex (including Brighton and Hove). It also cov ...
999 and 111
*
West Midlands Ambulance Service
The West Midlands Ambulance Service University NHS Foundation Trust (WMAS) is responsible for providing NHS ambulance services within the West Midlands region of England. It is one of ten ambulance trusts providing England with emergency medic ...
999 and 111
*
Isle of Wight NHS Trust
The Isle of Wight NHS Trust is an NHS trust which provides physical health, mental health and ambulance services for the Isle of Wight.
The trust is unique in being the only integrated acute, community, mental health and ambulance health care pro ...
999 and 111
*
South Central Ambulance Service
The South Central Ambulance Service NHS Foundation Trust (SCAS) is the ambulance service for the counties of Berkshire, Buckinghamshire, Oxfordshire and Hampshire. It is a foundation trust of the National Health Service, and one of ten NHS ambul ...
999 and 111
*
North West Ambulance Service
The North West Ambulance Service NHS Trust (NWAS) is the ambulance service for North West England. It is one of ten ambulance trusts providing England with Emergency medical services, and is part of the National Health Service, receiving direct ...
999 and 111
*
Yorkshire Ambulance Service
Yorkshire Ambulance Service NHS Trust (YAS) is the NHS ambulance service covering most of Yorkshire in England. It is one of ten NHS Ambulance Trusts providing England with emergency medical services as part of the National Health Service it r ...
111
*
London Ambulance Service
The London Ambulance Service NHS Trust (LAS) is an NHS trust responsible for operating ambulances and answering and responding to urgent and emergency medical situations within the London region of England. The service responds to 999 phone cal ...
111
In addition, all NHS 111 providers including: Vocare, Practice Plus Group (PPG), IC24, DHU Healthcare and HUC, use the NHS Pathways System to assess NHS 111 Calls in England.
History
NHS Pathways evolved following reports by the
National Audit Office (NAO) into the inconsistency of 'hear and treat' statistics across the ambulance services of the United Kingdom. In June 2011 it was approved by the NAO "as a way to make substantial savings and improve efficiency in ambulance services."
Its development was intended to coincide withand be integrated intothe growth of the new non-emergency healthcare system
NHS 111
111 is a free-to-call single non-emergency number medical helpline operating in England, Scotland and parts of Wales. The 111 phone service has replaced the various non-geographic 0845 rate numbers and is part of each country's National Health S ...
.
By October 2011, the
Department of Health
A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their ow ...
announced plans to extend NHS 111and Pathwaysacross the UK by 2013 to replace NHS Direct.
Its role in emergency medicience received media coverage from the
BBC #REDIRECT BBC #REDIRECT BBC #REDIRECT BBC
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that focused on the hope that it would reduce unnecessary ambulance dispatches as an improvement on the existing AMPDS or criteria-based dispatch systems. The
North East Ambulance Service
The North East Ambulance Service NHS Foundation Trust (NEAS) is an NHS foundation trust responsible for providing NHS ambulance services in North East England. Headquartered in Newcastle upon Tyne, NEAS provides emergency medical services to th ...
, already using NHS Pathways, declared that it reduced such call outs by 2,000 per month.
Using an attached capacity management system (CMS) NHS Pathways can analyse the medical services local to each caller, and thus direct the patient to nearby minor injury units or doctor's surgeries depending on the presenting condition. The NHS launched Pathways with the example of an adult female with an arm laceration who – upon being triaged by NHS Pathways via NHS 111 – was directed to a minor injuries unit one mile from her home that was identified by the CMS function of NHS Pathways as being suitable. In theory, any patient with any medical condition can contact any telephone-based medical care provider (999,
NHS 111
111 is a free-to-call single non-emergency number medical helpline operating in England, Scotland and parts of Wales. The 111 phone service has replaced the various non-geographic 0845 rate numbers and is part of each country's National Health S ...
, out-of-hours GP) and be directed to any care pathway, be it ambulance, doctor, nurse, or emergency department, using one system.
In January 2021 it was reported that the use of digital healthcare in UK had soared in 2020 with the number of 999 and 111 calls NHS Pathways had dealt with rising by 2.5% over the period of one year and August 2020 seeing the highest increase of 17.7% to August 2019. In June 2020 it was reported that NHS Pathways had made more than 300,000 referrals since its launch and that its algorithms had been updated to reflect the need for patients with
Covid-19 symptoms
The symptoms of COVID-19 are variable depending on the type of variant contracted, ranging from mild symptoms to a potentially fatal illness. Common symptoms include coughing, fever, loss of smell (anosmia) and taste (ageusia), with less commo ...
to be referred to the NHS 111 Covid Clinical Assessment Service. This in turn also ensured that patients with non-Covid-19 symptoms, where clinically appropriate, could be referred the Community Pharmacist Consultation Service (CPCS). In August 2020, it emerged that NHS111 online experienced record usage with more than 30 million users visiting NHS111 online between 26 February and 11 August 2020, due to the Covid pandemic. Its newly introduced dashboard, based on the volume of triages going through NHS Pathways, proved itself as a valuable indicator for getting early warnings about potential local outbreaks. NHS111 online became a reliable and trusted source of NHS and government guidance on the pandemic, also connecting the public to additional digital services related to
coronavirus
Coronaviruses are a group of related RNA viruses that cause diseases in mammals and birds. In humans and birds, they cause respiratory tract infections that can range from mild to lethal. Mild illnesses in humans include some cases of the com ...
, such as the issue of isolation notes or sending text messages to support patients who were managing their illness at home. In October 2021, having dealt with almost 20,000 suspected
cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possib ...
patients, it emerged that NHS Pathways was well equipped to identify cardiac arrests and escalating priority of ambulance response, as well as instructing and supporting members of the public in administering
CPR
Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore sponta ...
successfully, considerably increasing the patient’s chance of survival.
Notes
References
* {{cite press release , url=http://www.improvement.nhs.uk/cancer/LinkClick.aspx?fileticket=p%2F4LCfr%2BGOs%3D&tabid=264 , title=NHS Pathways - Integrating Urgent and Emergency Care , publisher=National Health Service Clinical Directorate , date=May 10, 2011 , accessdate=2013-06-06
Triage
National Health Service (England)
Health informatics in the United Kingdom
Health software
Emergency management software