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?

@TatianaLarina Exactly, it isn't rocket science. The only reason I didn't think it was a DVT was because I'd had awful sciatica for the previous three days so was convinced I had causing equine, which I know is a medical emergency as well but maybe not as serious.

cauda equina

The 111 service has been fantastic when we've needed to use them, however if I've ever come across anything with my children that I thought was particularly urgent I went straight to A&E with them. I don't know what the answer is here as obviously the deaths of these children are awful but there needs to be a system in place so that when it comes to children we all err on the side of caution with illnesses.

My DD had a horrendous experience over Christmas with my DGD who was dreadfully unwell. She had a fever, abdominal pain, and was screaming in pain......... she went to OOH twice, diagnosed with a virus, sent home. In desperation DD took her into A & E, where they saw the rudest nurse imaginable who sent them back to OOH.... DD waited nearly 7 hours to be seen, by this time DGD was vomiting. Told it was noro, why had DD brought an infectious child in....... sent home again. By 27th Dec, this had been going on for 4 days and DD again phoned 111.... thankfully one of our own GPs was on duty in OOH and they took one look at her and sent her straight up to PAU. DGD had a severe kidney infection, and had blood, protein and high levels of bacteria in her urine and was literally on the cusp of sepsis. Not one person she had seen over the 4 days had done a urine sample. She's only just been discharged from hospital and it was a horrendous Christmas for everyone...... which could have been treated in 1 visit and a urine dip.

I have no faith in the system at all right now.

Junie - if you could face following that up with a letter to the OOH practice and A&E - you could highlight the need to do urine samples with any abdominal pain and vomiting in children.

Presumably they didn’t prod her abdomen either - which could potentially have identified the origin of the pain was her kidneys.

Have used several times. They have been fantastic on all occasions.

I have called them when I know I need to see a GP, but not a&e and it's out of hours. Turns out I needed emergency surgery the last time so lucky I called when I did as 2 GPs and 2 breast consultants failed to recognise a breast abscess. By the time I was in unbearable pain (6 weeks later) I called 111 saw out of hours gp. This was at 2am. By 11am I was under anesthesia having the abscess drained. It was fit to burst through my skin.

I praise the out of hours team and all that work for 111. They can only do so much at the end of the phone.

I only ever had 1 problem with 111 when my youngest had difficulty breathing and a barking cough like whooping cough - a vile GP called us back and refused to see her. I ended up giving my asthma inhaler to her with steam from shower. She had awful URTI. Did follow up with local GP and he was so rude I walked out.

That said...

I have had numerous excellent experiences with my 2 then very young children seen within 2 hours or appropriately directed to A&E and on 2 occasions ambulances took children to A&E as very poorly. I also called them as I was worried about calling 999 and ended up in Resus as they directed the paramedics out to me promptly.

So, yes, I had one bad experience but many more good ones. I don't know how they manage with the volume of calls they get.

They are not infallible - but none of us is. And, does anyone ever intend to make a mistake? I have seen the impact on a GP of when they have made a mistake and believe me, they don't just brush it off - it has life changing impacts on them, too.

There's simply not enough money or trained staff.

I don't particularly ring for the advice of the 111 caller. Whatever they're going to tell me I can get from the NHS website. What I do use them for is to get a call back from a qualified GP / clinician who can advise me on necessary next steps.

DH was treated abysmally by 111 service. They focussed on the wrong symptoms, refused a doctor's visit, and as a result DH nearly died. I took him to A&E myself. We're persuing a legal case...

This 111 nonsense does not exist in any other country that I'm aware of

After hours telephone triage is a very common service internationally, and has been for decades

AUSTRALIA
www.publish.csiro.au/hp/HP050230

CANADA
journals.sagepub.com/doi/pdf/10.1177/0272989X9501500307

NETHERLANDS
academic.oup.com/fampra/article/28/3/334/482131

USA
1993 article
2003 article
jamanetwork.com/journals/jamapediatrics/article-abstract/345860
jamanetwork.com/journals/jamapediatrics/article-abstract/518615

My GP missed something that should have been fairly obvious. Within 24 hours, I was in multi organ failure on life support. I wasn’t expecting to live and I sustained a permanent injury. GP is only human and made an error. I didn’t call for my GP surgery to be shut down. I did request a change in protocol which has happened.

OP, another thread being very attacking with no ability to even listen. AIBU isn’t an echo chamber.

DH was treated abysmally by 111 service. They focussed on the wrong symptoms, refused a doctor's visit, and as a result DH nearly died. I took him to A&E myself. We're persuing a legal case...

Afaik it’s not in 111 power to organise a doctor’s visit unless you’re very old/housebound. (Happy to be corrected). They can arrange an OOH appointment or call an ambulance.

If someone is ill enough that they need an OOH doctor’s home visit as they can’t get to a surgery then they need to go to A&E.

A PP menions 'going private' but you still need NHS for emergency care.

If someone is ill enough that they need an OOH doctor’s home visit as they can’t get to a surgery then they need to go to A&E

Sorry, but that is simply incorrect and would overburden A&E.

Many home visits are for acute illnesses that do not require hospitalisation but can be treated with prescribed medication and /or bed rest - waiting in A&E is not the best place for them when emergency care is prioritised.

E.g. person with severe back pain who cannot move will be prescribed pain relief/relaxant to reduce the pain versus sitting in agony at A&E when it is an acute pain but not an emergency.

After hours telephone triage is a very common service internationally, and has been for decades

But those countries listed (apart from Australia possibly as it doesn't mention in the link whether its nurses or not) use actual nurses to do the phone triage. That makes a difference, they are medically trained.

@Tistheseason17

Severe back pain is not an acute illness (unless specifically associated with one like cancer) it’s an injury.

Acute illness and and injury cannot be assessed at home - tests would be required.

Ime the only home visits 111 will organise is for elderly or housebound who cannot get to a OOH GP.

Be interested to know if anyone has received an OOH home visit in other circs.

@MontStMichel

www.google.co.uk/amp/s/www.rollingstone.com/culture/culture-news/coma-birth-woman-arisona-hacienda-healthcare-776902/amp/

Things like this do happen! Hence why staff have to be incredibly careful before they do any procedure involving ionising radiation, which is incredibly dangerous to an unborn.

I work for an OOH provider, can confirm we don’t do any home visiting unless housebound or end of life.

I rang NHS direct, as it was called then, because I had woken to feed three month old DS and was in agony with stomach pains. I kept trying to go to the loo, then rocking on the bed, repeat....

I phoned, a Dr called me back within minutes. He said 'I am 23 miles away, you need medical help quicker than I can get to you and there are no ambulances available, can you get to MIU?'. I could, we woke 12 year old DD up and told her she was in charge of the babies (15 month old as well) , while DP ran me there, then dashed back.

The nurse in MIU looked after me for a couple of hours, while I waited for an ambulance.

I later had surgery for a strangulated hernia. Life or death stuff, as correctly recognised by them.

*and that’s housebound normally, I.e. does not visit own GP surgery, requires district nurses to visit for dressings, etc.

If a normally fit and healthy person has become so acutely unwell that they cannot physically leave the house they more than likely need 999.

I work for an OOH provider, can confirm we don’t do any home visiting unless housebound or end of life.

Thanks!

@TatianaLarina

We have home visits by OOH in our region - looks like it is different in different locations.

I have a chronic back condition (not an acute injury) and received a home visit to receive pain relieve as I could not move and no one could take me anywhere. I had not injured myself so A&E would not see me.

I am also aware of a friend whose mum received a home visit for torticollis - not an injury either, but acute pain and she was given amitripytaline.

OOH providers clearly offer different services in different regions.

My point is that A&E is not the place for everything and if everyone simply went to A&E the system will fall over... ok, well it is already, I guess!

I guess you could argue we were both temporarily housebound?!