111 failed to diagnose

[Shedidnt]

www.mirror.co.uk/news/uk-news/calls-nhs-111-helpline-probe-21216411?fbclid=IwAR3SMrfs8ptX0YbrlJozTL_PyeRzd2f6ijkqZsg_7P3EFkEi3F3Psbg2aAg

Am I correct in thinking that the warnings we are all given about not going to A&E needlessly is the cause of these deaths, and we're dealing with Joe Soaps and their questionnaires on 111 rather than trusting our own judgment?

While we were in the waiting room at A & E, someone came out and said everyone waiting to see the urgent GP could go now - half the room walked out! There would be more resources to treat people in A & E, if there weren’t so many people there, who were not accident or emergency!

@womenspeakout a bad chemical burn? Surely that needs A&E or emergency walk in clinic, not 111!!!!

Nothing is infallible. When I persuaded my mother's GP to go to see her about excessive bleeding and bruising, the GP simply shrugged her shoulders and said it was just because she was on Warfarin, and didn't bother with so much as a blood test. When she subsequently went to hospital they did the test and said they'd never come across such low levels of clotting factor. With hindsight, I suspect 111 would have advised A&E in the first place so would actually have been safer.

Tatiana
The surgical consultant came and felt her tummy which by then was notably bloated (couldn't pass wind), noticed she was guarding, sent her for ultrasound and it was seen then. Got transferred to bigger hospital and still waited 12 hours for emergency op (like orangeblossom, an open resection).

They didn't think of it because my child was older than typically, and had no redcurrant jelly stool or bleeding from rectum.

Misdiagnosis can happen at any point in the process though. A 7 or 8 year old died near me recently from meningitis that was missed by a GP and two paramedics. By the time the second GP recognised the signs, 999 said they couldn't send an ambulance for 3 hours. Parents had to drive the child to hospital themselves and it was too late to treat effectively by the time they got there. There is incompetence everywhere. If you think your child is seriously ill you take them to A&E or a walk in centre anyway, you don't wait for permission from 111.

111 is really useful for speeding things up, I've had my child admitted straight into the kids assessment unit at the hospital rather than waiting in A&E. The extent I agree with you is people need to understand it's a triage/appointment service and if you don't agree you don't just sit on your hands.

There's always things that stick out in these awful stories. The article says the little girl was "found unconcious" later which you often see and it baffles me. Surely you don't leave toddlers when they are very ill. A child that age can turn quickly - I'd never put them to bed in their room and leave them. One could argue that the need for small children to sleep independently at all times being "drummed" into us probably has some bad effects.

Faina so glad she got the Op. Yes in an adult they had never seen it before. Take care with adhesions in your daughter (internal scar tissue) can cause pain and rarely, more obstruction in the small bowel.

I really don't like the posts shared on fb that tell everyone when it is or isn't acceptable to use a&e. Not only patronising but it's stopping people with genuine concerns who don't want to be "time wasters". Even if you have attended a&e and been sent home with the all clear, if you had a genuine concern, better to be safe than sorry. There's no need to be shamed with all this "advice" being thrown about.

I’ve had mixed experiences.

For the great one, they picked up my child needed to be seen within an hour. The GP saw us immediately and admitted to hospital with signs of red flag sepsis. The call handler had arranged a safety call from the nurse in case we hadn’t manage to get seen by the GP and she rang as we were on our way to hospital.

For the bad one, I’m convinced they used the wrong algorithm as the questions didn’t work for a baby. They were more appropriate for an older child. The call handler told us to just stay at home and self-care which was stupid and I told them that (I’d actually called to find out which hospital to go to). It must have been flagged though as a nurse called me back and to go straight to hospital and ignore the call handler.

The thing about intussusception is it doesn't raise flags - bad tummy ache, vomiting, no fever. At 111 that is so much more likely to be noro and they can't advise that every child who has tummy ache and is being sick go to A and E. There should be a "if you are more concerned by this vomiting than by other times" clause or something. Plus brown vomit (my child only had one green vomit, then it changed to brown) should be a big flag.

Ive always found 111 very helpful, when i called them for my 3 month old who wouldn't stop crying, hardly breastfeeding, temp of over 38 and didnt like to be touched/picked up.
They sent out an ambulance, the paramedics looked quite pissed off and he said i dont think we need to be here but we have to take him in anyway as he is under 2... on the way his temp was hitting almost 40 and looked very unwell, paramedic soon back tracked on what he said...
Got down to childrens ward and the doctor was very concerned thinking he had meningitis due to the symptoms he had.
Little one had a lumbar puncture and a tonne of blood tests done, turned out it was a nasty urine infection (with is bad in babies, especially boys)
Luckily after a few days stay and a follow up kidney scan he was fine.
I was thankful 111 took it seriously.

@Shedidnt

Ok, why do you think other countries don’t provide an equivalent to the FREE 111 service?

Did you know that you are charged between $400 -$1200 just to ride in an ambulance in the States? If you are involved in an accident you will be billed for the ambulance that takes you to hospital. If you are lucky, you will have paid for medical insurance that covers you, but you will still pay an excess charge just like you do when you claim on your car insurance.
It’s not a free service.

It’s all very well saying if 111 service didn’t exist, patients could phone an ambulance and go straight to A&E but where will the extra ambulances and staff magically appear from?
If A&E have 100 extra patients turning up on every shift, who is going to treat them when they are already struggling to cope now?

The 111 service was designed to relieve some of the pressure on the NHS due to constant funding cuts both on the frontline and in the recruitment and training of suitable medical staff.

It will get far worse after Brexit when you will lose even more European staff, so you’d better get used to more people dying because of inadequate provision. It’s certainly not going to improve any time soon.

MN is worse than FB for telling people not to waste A&E's time.

The last time I was admitted to hospital, I actually hadn't the energy to ring 111 until I was close to death (I live alone).

It takes 10 minutes for them to get through their questions. I genuinely couldn't face it - I could barely hold the phone up, couldn't breath well enough to talk. With hindsight I should have just called 999, but you're so pre-conditioned NOT to call one that I could possibly have died. Another few hours and I'd have been dead.

Moral of the story - if in doubt - get to A&E and bypass 111.

Oh for goodness sake - please don't use the US as a bar to meet. I'm talking about EU countries.

It must be so hard to diagnose over the phone with the list of symptoms. I don't know what the answer is, I think it's a good service so there aren't loads more turning up at a and e.

I had a go a 111 job and fluffed the exam.

I found the training a nightmare. I was taken on for having a good phone manner with no proper interview. The training made the job look simple but the thought of telling someone they didn’t need an ambulance when they did terrified me so much it gave me anxiety.

A set of questions asked by someone with no medical background is hopeless, you can’t see the patient, I don’t see how any medical decision can be made from this. Some people are drama queens while many old people “don’t want to bother you” when the patient is having a stroke, this makes diagnoses from people talking down the phone impossible.

The girl who trained me was working on getting another job and most people didn’t want to be there. The job is still constantly advertised so I assume people are leaving all the time. I don’t trust 111.

I think it's a good service so there aren't loads more turning up at a and e.

Is it worth 5 children's lives?

111 is a great idea but I trained to do the job and I’m now convinced they need medical professionals on the phone, not people with no medical training.

This is just one of the many we get to see whilst the media tries to convince everyone paying for healthcare will be better

Where in the media is this happening ? There's no suggestion that 'free at the point of consumption' is changing, no matter how you might like to frame it. Having some private suppliers to the NHS is not that - and has been happening for years.

Our local primary heath care trust uses the local hospital physiotherapy - but they also use private physios for certain conditions. My student DD went to a local sports physio that we use as a family (not for a direct injury but for back pain something she thought was related to one from couple of years back) and he pointed out that the treatment required would probably qualify for funding of treatment if she went to the GP. She went, GP authorised, came back to physio and was treated. She could also have gone on the list for the NHS run physio at the local hospital - somewhere she is familiar with for an unrelated chronic condition. Going to this very specific physio freed up an appointment for others at the NHS clinic who have a much wider range of needs and treatments . I really don't see the problem, though I know it offends the idealogues who are totally inflexible on sources of provision.

I wouldn’t bother with 111 for anything serious you are asking someone to make a judgement on someone they can’t actually see! I just use my common sense. We’ve had 3 trips to a+e for our children in the past 2 years and each time we have just thrown them in the car and driven to a+e. If you know someone is unwell/had an accident serious enough to need to go to hospital it’s pointless. Nine times out of 10 an ambulance will be sent especially with small children, I said to my husband each time we went, 111 will just send an ambulance if we call and we can be there quicker anyway.

It just wastes resources in some instances, but then at the other end of the spectrum it misses people who are very poorly but they can’t physically see or examine, pretty flawed really. I’d always trust my own judgement over someone on the end of the phone.

When I was in a and e last, there was someone there with conjunctivitis, and a broken nail!!! No wonder we are at crisis point

An algorithm can never compensate for that

Yet AI is better than doctors hen used for diagnoses.

To all the posters saying they wouldn't use 111 - what would you do if you needed to see a GP and it was the weekend?

The last couple of times I have used 111 it's because DS had a staph infection and then this time a strep infection (which hadn't cleared with antibiotics).

Neither time was he particularly ill but there was signs that he had an infection. Surely using 111 is better than letting him deteriorate. And potentially end up in A&E?

I phoned 111 on Christmas Eve afternoon because I had a bad uti. I had a call back within 20 minutes and had seen a doctor and was back home with antibiotics within 2hrs of my initial phone call.

I think that was the first or second time I've ever used them. If I'm ill in office hours I always ring my GP and they're very good at fitting me in.

it worth 5 children's lives?

Of course not and you know I didn't mean that. What I mean is for those with mild problems like conjunctivitis or something similar then it's a great service.

The doctor's hen would be as useful as 111.