Patients benefit profoundly when clinicians use rapid Advice & Guidance:
- Instant reassurance, and reduction of stress or worry.
- Avoidance of costs and disruption through unnecessary hospital visits.
- The right care, faster.
- Instant reassurance, and reduction of stress or worry.
- Avoidance of costs and disruption through unnecessary hospital visits.
- The right care, faster.
Real-life patient experiences are re-told by clinicians in our videos and in the examples grouped by hospital specialty below.
Telephone A&G – Mental Health
Photo A&G
Acute Medicine
‘A patient presented with a swollen leg but had previously been to the Emergency Department. The symptoms persisted, and I was concerned that they may have deep vein thrombosis (DVT). I used the Consultant Connect App to contact a GP in the Acute GP Unit Medical Admissions Team at Singleton Hospital. Together, we decided on the best care for the patient, and which is the appropriate clinic or department to send them to. It was agreed that an urgent ultrasound scan was required, which I arranged for the following day. This was a great result for the patient, and the scan was organised for a time when they could easily get to the hospital. Using Telephone Advice & Guidance in this instance meant that the patient’s care was expedited.’
‘A 27-year-old patient presented with a one-week history of flu-like symptoms with a dry cough, vomiting and left-sided chest pain. She was noted to be pyrexial and tachycardic but had a normal-sounding chest and O2 saturations. I suspected it was either community-acquired pneumonia or influenza and wanted to request an urgent CXR. I called Acute Medicine via Consultant Connect and spoke to a local consultant who agreed that if the patient attended hospital, they would look at the CXR on PACS and call the patient with the results. The patient was prescribed antibiotics in case of pneumonia, but the CXR did not show any initial changes, though the radiologist did report signs of possible pneumonia. Using Prof-to-Prof Advice meant the patient was managed in the community, avoiding needing a hospital appointment.’
Cardiology
‘A 62 year-old fit and well lady presented with new breathlessness. A routine ECG conducted as a part of investigations showed some slight irregularities. I was uncertain of the significance in relation to her symptoms of breathlessness so used the Consultant Connect App to take pictures of the ECG with patient consent and request consultant review of the trace.
‘The cardiologist was able to reassure us that this was not a cause for concern and that no further action was required. The patient also felt reassured. Her breathlessness was monitored and “subsequently settled spontaneously”.’
‘I answered a call from a GP about atrial fibrillation and general management for a patient. The GP did not feel that the patient needed anticoagulation medication, at least until all of the tests were in. I informed the GP that the patient was at a very high risk of having a stroke and whatever the tests showed, the patient still needed anticoagulation drugs and these should be started at that time. As the tests could easily take 3-4 months, this protected the patient against a possibly devastating stroke much earlier than originally planned. This was a good outcome and the GP was pleased with the advice.’
‘I saw an elderly patient because she was breathless. She was last seen by her local cardiology team 18 months previously with some narrowing of the aortic valve. I found that she had fluid retention, including swollen ankles, and a heart rhythm disturbance, which was atrial fibrillation. I was aware that atrial fibrillation in an elderly patient with heart problems creates a very high risk of blood clots in the heart, which can cause a stroke. Therefore, I needed to start blood-thinning drugs as soon as possible. Still, I wasn’t sure of the interaction with the patient’s abdominal aortic aneurysm, which would be life-threatening if ruptured. I contacted Dr Davey via the Consultant Connect App and was very grateful for his input in my patient’s case. Dr Davey’s thorough advice was didactic and helped me a great deal in deciding on a management plan and to expedite the referral to the anticoagulant clinic.’
‘I required advice for a patient who was suffering from leg oedema and had known cardiovascular disease. I wondered if the patient was experiencing left ventricular failure as their ECG was grossly abnormal. My paramedic colleague and I were unsure whether the changes were acute or due to the patient’s pacemaker. There were no previous ECGs on the patient’s record to compare to, which made it much harder to work out if the problem was acute. I used the Consultant Connect App to send the patient’s ECG images via the IG-secure clinical photography feature, PhotoSAF, to a local cardiologist who was happy to reassure me that the ECG by itself was not concerning. The consultant rang me within minutes of receiving the ECG and followed up with a written response. He provided very prompt and helpful advice. The patient benefited from the input of a specialist whilst avoiding an unnecessary trip to the hospital. The patient was reassured, and both the patient and I were relieved.’
‘I saw a young adult patient who presented with atypical chest pain. I carried out an ECG, showing some unexpected and unexplained features. I wanted to discuss the results with a cardiologist, so I used Telephone Advice & Guidance via Consultant Connect. The cardiologist reviewed the ECG and advised that the patient needed to be referred to the outpatient department for further assessment. On another occasion, I saw an elderly patient who had stents fitted abroad, and their medication had run out. The patient had had two previous myocardial infarctions and reported 4-5 stents being present, but all medical notes provided were not in English. Due to the procedures being carried out abroad and the ongoing medication advice given to the patient not matching the local NHS equivalents, I was uncertain of the next steps. I used Consultant Connect to speak with a cardiologist, and together, we worked out what medication the patient needed to stay safe in Primary Care whilst awaiting their outpatient appointment.’
‘I saw a 72-year-old patient who had bradycardia, presenting with slow atrial fibrillation. The patient had a history of myocardial infarction, and, as their heart rate was at about 50, I was not sure whether they needed pacing. I used the Consultant Connect App to contact a cardiologist for advice on the patient’s ECG. They explained that the patient did not need pacing, which was reassuring as it meant that an urgent referral was not necessary. The cardiologist advised on the management of the atrial fibrillation, which we started in the community.’
‘A patient had recently returned from holiday where he had experienced chest pains and had gone to the local hospital, where he was diagnosed with pericarditis. I then saw the patient a few weeks later with ongoing symptoms. I called Dr Davey via Consultant Connect to determine whether the symptoms matched the diagnosis. Dr Davey reassured me that this was the case and that some simple outpatient tests and treatment for the patient’s inflamed pericardium were appropriate. I find Consultant Connect very convenient for getting quick advice when needed from specialist consultants. I was put through quickly and gained the information I needed to manage the patient effectively. The patient felt at ease that this would all be done whilst he was in the clinic with me, and he did not have to wait for an answer or return later. By speaking with Dr Davey directly, the patient was more involved in his care and decision process and felt comfortable that our advice was appropriate. From my point of view, it felt like a more connected approach without the divide between primary and secondary care.’
‘I had a patient with heart palpitations come to see me. These had been proven by ambulatory ECG monitoring to be benign ectopic beats, but due to their history of hospital admissions for asthma, beta-blockers were contraindicated. I used Consultant Connect’s Prof-to-Prof Advice to speak with a consultant cardiologist. This service allowed me to discuss the option of introducing a calcium channel blocker, which I had seen being used for other patients in the past, but I wasn’t confident enough to commence.’
Community Mental Health
‘I received a call last month about an 80-year-old lady who was diagnosed by our memory service with Alzheimer’s disease three years ago, but who was not currently under Secondary Care. Over the past three months, she has become more forgetful and had developed some paranoid symptoms, believing her neighbours had a spare key, were entering her property when she was asleep, and hiding objects around the house. She was quite distressed about this but through discussion we were able to establish that there were no acute risks to herself or others. I reviewed her medication and did not feel she was on any that were likely to be worsening her cognition. Her GP had helpfully carried out some baseline bloods and an MSU (urine test) which I reviewed, and found that no physical factors were causing her deterioration. She was already on donepezil but no other psychiatric medication. I was able to advise that she should start on memantine and I advised on a dose of titration which her GP was happy to monitor. We agreed she did not meet the threshold for prescribing an antipsychotic at this stage or need a referral to the older adult CMHT at this point, but that she could be referred to us if there is no improvement in her symptoms with the memantine or if the risks increase. Her GP was happy with this plan, and said they had thought this would probably be the treatment plan, but they had found it helpful to check the plan was appropriate, and it gave them confidence in managing the patient going forward.’
Dermatology
‘I recently saw a patient who had a skin condition called hidradenitis suppurativa. They were in a lot of pain and were regularly going to the hospital to have abscesses drained. This continued to the point where the patient was expressing suicidal thoughts because of the constant agony they were in. We had tried all options available to us, and the next step was a referral to Secondary Care. I sent a message to the Dermatology specialists at University Hospitals Coventry and Warwickshire via the Consultant Connect App, and they responded with a management plan for the patient. The response was very quick and detailed, and the patient is much happier now; it was a great outcome.’
‘A patient came to see me with a cutaneous horn-type lesion on his upper chest. The patient had a history of fair skin and sun exposure, so I was concerned that the lesion might be an early Squamous Cell Carcinoma (SCC). I sent a photo via the Consultant Connect App, with the patient’s consent, for Dermatology Advice & Guidance. The consultant agreed that it could be an early SCC and advised a two-week wait (2WW) referral. I was able to share the image with the consultant, and I received a response within the hour containing their clinical advice. Putting the patient forward for a 2WW referral was the best result because it fast-tracked the referral and meant that the condition was being managed efficiently.’
‘A patient with a facial rash presented, which was presumed to be seborrheic dermatitis. As the patient wasn’t responding to standard treatment, I used Photo Advice & Guidance to take patient photos to send to the Dermatology Team at Guy’s and St Thomas’ NHS Foundation Trust. I received a response from a consultant dermatologist advising me to try an alternative rosacea treatment. With this alternative treatment, the patient’s condition improved rapidly.’
‘I saw a patient who had been taking Tamoxifen following a mastectomy for breast cancer. She had developed an extensive itchy blanching rash on her limbs and chest. It was so extensive that she called an ambulance, who advised her to stop taking the Tamoxifen and make a GP appointment. She used antihistamines, stopped the medication and saw me after one week with no improvement. I was concerned about a medication reaction and started her on Prednisolone. After two days, the rash had still not improved. I used the Consultant Connect App to send photos of the rash to a dermatologist. Within 24 hours, I had a response saying that there was no evidence of Erythema Multiforme or Toxic Epidermal Necrolysis and that the rash was in keeping with a drug rash with possible mild Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) but without system symptoms. The dermatologist concluded that the Prednisolone treatment could be continued with the addition of a topical steroid and emollient, adding that a referral should be considered if there was no improvement after a week. A week later, the rash had resolved, which avoided a referral for the patient. It was a relief to the patient that the rash had cleared up and reassuring to me, as a GP, that the proposed diagnosis and management were safe.
‘I recently saw a patient with a rash on their knees and feet, which was being treated as psoriasis but was not improving. I took photos of the rash with the patient’s consent via the Consultant Connect App and sent them to the Dermatology Team for Advice & Guidance. A dermatologist diagnosed the rash as lichenified eczema and suggested steroid cream. The rapid service meant the dermatologist provided an accurate diagnosis and effective treatment. The patient’s rash settled within three days.’
‘I recently had two patients suffering with lichen planus and infantile eczema. On both occasions, I received rapid responses from dermatologists at University Hospitals of Coventry and Warwickshire NHS Trust (UHCW) about how to treat and manage the conditions. The use of Photo Advice & Guidance resulted in a great outcome for both patients as they received prompt management of their skin conditions. This is a very good service – timely, easy-to-follow guidance, with the ability to re-open cases for further discussion.’
‘A patient suffering with a rash came to see me. The patient also had coeliac disease, so I wondered if the rash was dermatitis herpetiformis. I took some photos via the app with the patient’s consent and sent them to a local dermatologist for advice. They came back and confirmed that the rash was in fact pompholyx. I then called the patient back within five minutes to confirm the appropriate diagnosis alongside a management plan. I received rapid clarification on the diagnosis which was great for the patient and meant that they received a management plan put together by a specialist without needing to attend hospital. Virtual management plans put together in this way are a brilliant tool, especially during COVID-19, as patients can be managed without needing to visit another healthcare setting.’
‘I saw a patient who had suspected severe hand dermatitis. I recognised some of the symptoms based on my own experience. To ensure my initial thoughts of the patient’s condition were correct, I took some photos with the patient’s consent. I forwarded them on the Consultant Connect App to a consultant dermatologist on the NCN. The dermatologist confirmed that the patient needed systemic treatment only provided in Secondary Care. I was pleased that although the waiting time for dermatology is extensive, it was an appropriate use of the waiting list in this case. The patient was glad to see the end of many doctor appointments and instead receive the specialist treatment they needed. They also felt that their condition was being taken seriously. I felt reassured that the referral was appropriate and necessary for the patient’s care, and that the response was received very swiftly.’
‘I recently saw a child with an itchy body rash and a history of eczema. As I was unsure if this particular rash was eczema, I took photos of the patient using Photo Advice & Guidance to send to the Dermatology Team. I received a written response from a local dermatologist the next day, who diagnosed the rash as chronic eczema with lichenification and follicular morphologies. The consultant had also written a detailed patient management plan. The patient was provided with the correct treatment plan early on. They did not need to wait for a Dermatology hospital appointment, and a potential hospital referral was avoided.’
‘I had been suffering from a small lesion for six weeks and was concerned it could be an early skin cancer. During my appointment, Dr Davies took photos and shared them via the Consultant Connect App for specialist Advice & Guidance. I felt reassured that Dr Davies took action this way. I knew I would get a swift response without going to the clinic for a diagnosis. I also trust her judgement, and as it was, the result came through very promptly. Because Dr Davies shared my images this way, I avoided an unnecessary trip to hospital. The service seems more efficient and timely and uses less staff. Had my condition been more serious, I would have got the treatment I needed at an earlier date and, on that basis, I suspect it is more economical as well.’
Diabetes and Endocrinology
‘I recently spoke with a local GP who was seeking advice about a patient with Type 2 diabetes. They wanted rapid advice because the patient’s control had fluctuated rather considerably. The GP explained the patient’s history and asked whether they ought to consider scans for the patient to exclude malignancy. I was able to reassure both the GP and the patient that the fluctuations were likely caused by patient-initiated changes to lifestyle, which the GP subsequently confirmed after reviewing practice nurse notes, and so I didn’t need to consider any scans for the patient.’
‘I saw a patient who had a lump in their neck and was concerned that it was malignant. To help manage their worries, I used Consultant Connect to call a local consultant endocrinologist. The consultant helped me manage the risk because they were able to explain to the patient that there were investigations they could do to gain more information. The patient appreciated the real-time specialist opinion, felt reassured due to the consultant’s knowledge and left the appointment with further investigations in place. I felt reassured knowing that I had an extra level of input and could utilise the patient’s appointment to start further investigations efficiently.’
‘I had a patient who was referred to Endocrinology for hyperthyroidism and was started on carbimazole in the meantime. I was periodically monitoring her thyroid function tests on the new medication, and her results consistently improved. As she had still not received an outpatient appointment from Endocrinology, I used Consultant Connect to speak with a consultant endocrinologist for advice on the medication dosage and how to reduce it.’
‘I recently used Consultant Connect to contact a local endocrinology consultant for advice on levothyroxine dosing for a pregnant patient with hypothyroidism. The patient had a history of complications during past pregnancies and was anxious that her thyroid condition was adequately managed. The consultant guided me on adjusting the dose for the patient during pregnancy and advised on the intervals of when to repeat blood tests. Being able to speak with the consultant directly and during the consultation with the patient meant that I could reassure her there and then.’
‘After seeing a patient who potentially had type 1 diabetes, I was unsure if they should be started on insulin or oral hypoglycaemics. Usually, I would manage type 2 presentations but admit children or teenagers presenting with type 1 to paediatrics. The patient was anxious to act on the situation and wanted answers straight away. I contacted the Diabetes and Endocrinology Team via Consultant Connect, and they understood the difficulty in defining this type of diabetes. After the conversation, they started the patient’s management the same day through the diabetes nurse in the hospital clinic. Admission was not indicated, but a referral to outpatients would have taken some weeks at least. It felt reassuring to have the management started within a few hours of the diagnosis. This was a great result.’
Elderly Care
‘I saw an 88-year-old patient who was profoundly hyponatraemic which caused bradycardia and dizziness. The patient had recently undergone tests to investigate retinal artery occlusion. The urea and electrolyte results came back from the lab late in the day, but using the Consultant Connect service, I was able to speak to a consultant immediately to discuss follow-up options. The consultant advised that the patient be seen in the Department for Medicine for the Elderly the following day, where appropriate investigations could be performed, and medication reviewed. This meant that a late evening admission was avoided, and the patient’s current functional status could be discussed with the consultant who was planning the appointment.’
‘The Recovery at Home Team was concerned about an elderly patient living independently. She was known to have chronic obstructive pulmonary disease but had recently become more breathless. She complained of weight loss and a poor appetite and explained that she had been collapsing at home. She was recently seen in the Emergency Department, but they felt she wasn’t improving. We arranged an urgent outpatient clinic appointment which she attended. We assessed her with access to her medical records and previous investigations. Blood tests, an ECG and lying and standing blood pressure were checked, and advice on medication changes was given. We liaised with other services involved in her care. This enabled the patient to get the assessment and support she needed without an emergency admission.’
‘An elderly patient had become anaemic but was not symptomatic enough to merit an acute admission to hospital. The patient did not tolerate oral iron supplementation. I quickly discussed the symptoms with a consultant via Consultant Connect, and we agreed that reviewing the patient as a non-emergency was the most appropriate option to help the patient and that an IV iron infusion was needed. The consultant advised that a morning appointment would be best for the patient as it would be quieter and, therefore, the risk of exposure to Covid would be lessened. Being able to rapidly contact a specialist consultant in this way meant that I secured the patient an early Saturday morning appointment to be reviewed and have the IV iron infusion carried out. Rapid Telephone Advice & Guidance meant the patient’s care was expedited safely.’
‘I saw an elderly patient who was awaiting a hip replacement. The operation was cancelled by the anaesthetist because the patient’s sodium level was low, and they were slightly anaemic. I carried out initial investigations but couldn’t find a cause. I used Telephone Advice & Guidance to speak to an elderly care consultant, who explained that anaemia is not a contraindication and that the patient could be transfused. I arranged further investigations for the cause of the low sodium level or hypernatremia. I could then refer the patient back to orthopaedics for their operation. Getting this type of advice quickly improved the patient’s care. Without the service, it may have taken three months for them to see a consultant, and by that time, the patient could have been presenting with new clinical conditions. Using the service was a good experience for myself and the patient.’
‘I called the Care of the Elderly (COTE) line regarding a patient for whom I wasn’t sure if an admission was in their best interests. It’s all about what is necessary: Do they need a diagnostic right now, or can we operate a “wait and see” approach? The consultant was very helpful and advised that the patient should be seen the same day in hospital for investigations and that they would take things from there.’
Emergency Medicine
‘During a recent weekend shift, I attended to an elderly patient in severe pain due to a large swelling in their groin. After learning the patient’s past medical history and performing an examination, I was concerned that they were suffering from a strangulated hernia. Our current guidelines require us to convey all surgical cases, except abdominal aortic aneurysms, to Perth Royal Infirmary in the first instance of assessment. I used Consultant Connect to obtain telephone Emergency Medicine prof-to-prof advice to speak with a senior consultant. I raised my concerns that it would be detrimental to the patient to have them taken to Perth Royal Infirmary for assessment, only then to be transferred to Ninewells Hospital for the immediate attention his condition required. Through immediate discussion with a senior consultant at Ninewells Hospital, we agreed to bypass Perth Royal Infirmary and transfer the patient directly to Ninewells Hospital, which helped speed up their treatment.’
‘I recently spoke to an A&E consultant via the Emergency Medicine line on Consultant Connect regarding a patient experiencing what had the potential of a stroke mimic. I thought the patient was experiencing Bell’s Palsy, so I decided to use telephone prof-to-prof advice to discuss a few steps to confirm this suspected diagnosis. The advice I received gave me the confidence that the best pathway for the patient would be to refer to their local GP rather than undertaking a journey to hospital. The patient was happy that the outcome resulted in a local appointment with the GP rather than carrying out an 80-mile round trip to hospital.’
ENT
‘I recently saw a patient who had persistent symptoms of Benign Paroxysmal Vertigo (BBPV). I had already performed three Epley manoeuvres, which led to a partial improvement in the patient’s presentation, and I was beginning to consider a referral to ENT. However, I was aware that if the patient was referred, they would most likely wait months before an initial appointment. I used Telephone Advice & Guidance via Consultant Connect to obtain specialist advice regarding the patient’s condition. I was connected to a very helpful ENT consultant on the National Consultant Network. The out-of-area NHS consultant gave me recommendations and advice on what to try next before considering a hospital referral. The consultant explained that the patient should try home exercises (Brandt-Daroff) regularly for four weeks. The patient left the consultation with more confidence to try home remedies and was more motivated to persist with these. They felt reassured with the care plan in place, they received the right care efficiently, and they avoided a referral and a long wait for a hospital appointment.’
Frailty
‘A patient of mine had been admitted to hospital a couple of times and recently discharged, and I felt she had an underlying and deep-seated infection. The patient hadn’t been scanned whilst in hospital, and I felt that a scan without an admission would support my management of her. I called the Acute Frailty line via Consultant Connect, and the consultant geriatrician arranged the scan for the patient as an outpatient without her needing to attend any appointments beforehand. I would have had to admit her if I hadn’t had access to the Acute Frailty line. As a result, this allowed the patient to stay home and avoid an unnecessary admission, improving her care journey and ensuring she got the care she needed fast.’
Gastroenterology
‘A GP called via the service to ask for advice about treatment for H. pylori in a young child. Although not a paediatrician, as an adult gastroenterologist, I was able to discuss whether or not this warranted treatment, rather than discussing specific treatment methods. The GP found this extremely useful and was very pleased to be able to talk it through with a specialist.’
‘In many parts of the country, there are gaps in the communication between Primary and Secondary Care. Patients have had colonoscopies or flexible sigmoidoscopies due to diarrhoea, and consequently, colitis has been diagnosed. The report to Primary Care often indicates that a gastroenterology appointment has been arranged, with no treatment started, but the appointment isn’t for several months. The Primary Care clinician and the patient are then both in limbo and unsure of how to proceed.
Answering A&G queries via Consultant Connect allows me to recommend treatment in the meantime. A lot of treatments for gastroenterology are protocol-led, and therefore straightforward, meaning the patient doesn’t need to attend A&E.’
Shenaz shared how a patient’s blood test showed elevated alanine aminotransferase levels, so she contacted a consultant paediatric gastroenterologist via the Consultant Connect App:
‘The consultant advised me to order an ultrasound scan for the patient and repeat liver function tests. His advice was helpful, truthful, and non-judgemental, which ultimately helped me provide the best care for my patient.’
One of my patients presented with obvious inflammatory bowel disease, but it wasn’t clear what the best course of action was, and I was hesitant to begin the patient on steroids. I called a local gastroenterologist via Consultant Connect, who recommended the commencement of steroids in addition to an urgent outpatient clinic referral. This avoided an acute admission for the patient, who was very satisfied with the advice.’
‘A patient presented with bloody stools and a history of inflammatory bowel disease. The patient was unwell enough to justify a hospital admission, but I didn’t feel they could wait for an “advice only” SCI letter response. Using Prof-to-Prof Advice allowed me to discuss these concerns with a consultant gastroenterologist, who advised on a management plan, which I commenced. The patient was also then allocated an urgent appointment with treatment in situ in the interim. The patient was reassured, and treatment was commenced quickly to relieve their distressing symptoms, and they got the right care faster.’
‘One of my patients was facing a delay in decision for complex gynaecology surgery due to their consultant being on long-term leave. The patient was very anxious the delay would make surgery harder and less successful. They had been “primed” with a hormonal injection and anticipated a scan to assess changes to help plan surgery. Telephone Advice & Guidance allowed me to seek rapid advice from a gynaecologist who understood the complexity and time-criticality of the situation. They offered to get the patient re-assessed on the 2-week pathway. The patient was relieved by this, and thankful for the management plan.’
General Medicine
‘General Medicine is a specialty I use frequently, and recently I sought Advice & Guidance from a consultant via this line regarding a patient whom I suspected had rhabdomyolysis. The patient presented fit and well; he had previously undertaken intense exercise and was passing dark urine. I took his bloods late on a Friday afternoon, but I was worried about the patient not being seen until after the weekend. After speaking with the consultant, they were able to alert the senior housing officer to chase the blood results, and this resulted in the patient being admitted later that evening. It was a really effective way of preventing the patient from being sent to wait in A&E, which relieves pressure on ED. The patient was grateful for this and the fact that the communication between Primary and Secondary Care was positive and cohesive. The conversation was a good example of working together to ensure the smoothest journey for the patient.’
Gynaecology
‘I recently called a consultant gynaecologist via the Consultant Connect App after seeing an 80-year-old patient presenting with lower abdominal pain. She had been referred for an ultrasound scan, which was reported as a distended endometrial cavity; however, the patient had had no per vaginum bleeding or weight loss. The consultant advised making an urgent, but not a two-week wait, referral to gynaecology for the patient to be seen by a specialist. The response was immediate, and I could make a rapid decision about the best care for the patient.’
‘A 54-year-old female presented with obvious advanced cancer. The two-week wait (2WW) referral had been done. I tried ringing 2WW but because this line is not staffed by a clinician, I was unable to move the appointment from 14 days and the patient was deteriorating. When using Telephone Advice & Guidance, I was put through to one of the gynaecologists within seconds and they arranged for the patient to be scanned that day and given appropriate follow-up treatment. This would have been an acute admission otherwise. An acute admission was avoided, and the patient was given the care they needed.’
‘A young female patient came to see me as she was suffering from excessive prolonged bleeding whilst using the progestogen-only pill (POP). The patient could not use the combined oral contraceptive pill (COC), so I used Consultant Connect to obtain rapid advice from a local gynaecologist on the most suitable option. Using Telephone Advice & Guidance in this way resulted in the patient feeling relieved that their problem was being dealt with in a timely and efficient manner.’
‘I recently saw an antenatal patient after her midwife suggested she discuss starting Acyclovir Prophylaxis in the late stages of her pregnancy due to a history of recurrent genital herpes. When I saw the patient, she was well with no symptoms of genital herpes, so I decided to make a Telephone Advice & Guidance call via Consultant Connect to discuss the case with a local consultant gynaecologist. The call was very useful as they advised me that the guidance surrounding this had recently changed. Research had actually shown it is better for patients with recurrent herpes to be on Acyclovir Prophylaxis from 36 weeks. The patient was very satisfied that the recommended management plan, to prescribe the medication, came from a consultant who was aware of the new guidance. The patient felt reassured because of the consultant’s specialist opinion and felt safer taking the medication following this call.’
‘I had a female patient who had received results indicating anaemia and she had also been experiencing menorrhagia. I used Consultant Connect to speak with a consultant gynaecologist to receive further specialist advice. Given the degree of anaemia, I wondered if she might need an admission for a transfusion. Upon speaking with the gynaecologist, she advised that iron tablets should be sufficient for haemoglobin of 7, as it would likely increase the level by 1g per week, and the patient was relatively asymptomatic and not keen for admission. We also discussed the treatment the patient had tried for menorrhagia previously and we developed an alternative management plan. The consultant arranged for the patient to be seen in her clinic. Through the use of Prof-to-Prof Advice, the patient received direct specialist advice which enabled her to avoid an admission for a transfusion. The patient was delighted with the specialist advice and the fact that she received advice for her condition via me.’
‘I used Consultant Connect to seek Gynaecology A&G for a patient approximately a year ago.I spoke to a specialist very quickly who was absolutely fantastic and saved the patient many problems. The patient presented with a third-degree prolapse, and, before Consultant Connect was implemented, she would have had to wait multiple months for an outpatient appointment. However, when I spoke to the gynaecology specialist, they arranged to see the patient on the ward that same day, ensuring the patient got the care they need fast. I saw the patient again recently for a check-up, and she was incredibly grateful for rapid intervention, and she had already had her surgery.’
Haematology
Dr Moldovan recalled receiving a patient’s bloodwork which showed raised haemoglobin and haematocrit levels:
‘I spoke with a consultant haematologist who reassured me that a referral to Secondary Care was not necessary, which I then shared with the patient. They were pleased and relieved that their case was discussed with a specialist promptly.’
‘I saw a patient with chronic facial swelling of about six weeks and I was concerned with the possibility of vena cava obstruction. I spoke with a consultant at my local hospital via Consultant Connect to discuss the patient’s condition. I wanted the patient to have a chest x-ray urgently but, due to the current Covid-19 climate, I wanted to avoid an unnecessary trip for the clinically vulnerable patient. The consultant arranged for the chest x-ray to be carried out that afternoon and looked at the film themselves, allowing us to urgently investigate as an outpatient. This was a great result for the patient as it meant they got the right care faster, reassuring them that their problem was being dealt with efficiently.’
‘I saw a patient who had recently been diagnosed with an extensive deep vein thrombosis (DVT). She exercised frequently right up until the diagnosis, and during my follow-up appointment with her, she mentioned that she was on her way to an exercise class that day. As the patient had only just started on a direct oral anticoagulant (DOAC), I used Consultant Connect to speak to a haematologist for advice on whether there was a minimum amount of time a person should be on a DOAC before resuming exercise to reduce the risk of thromboembolism. The consultant was really helpful and advised that, although there was very little evidence on this, the consensus opinion was that it was safe to exercise as soon as the DOAC was started, as its primary mechanism of action was to stop clot extension. We concluded that the patient could continue to exercise, assuming it was not causing her any symptoms or pain.’
‘I was the on-call doctor one day and received abnormal blood results for one of my patients who had leukaemia and was under the care of a haematologist. The patient was undergoing chemotherapy, but the blood result indicated a sudden drop in haemoglobin and platelets. I used Telephone Advice & Guidance via Consultant Connect to contact Haematology and luckily was able to speak to the patient’s consultant. As she knew the patient already and could see the results, she immediately took over the patient’s care, contacting them and managing them going forward. Had I not used Telephone Advice & Guidance, I would have had to admit the patient through the Emergency Care Unit (EMU) or Acute Medical Unit (AMU) which would have meant an increased wait for the patient and going through inappropriate services.’
‘I saw a frail 85-year-old patient in a nursing home with a history of schizophrenia and dementia, who had developed abnormalities in their full blood count. In a younger patient, I would have referred urgently via rapid access but, given the patient’s comorbidities, I wanted to know what investigations would be considered and how invasive they might be. After calling Haematology Advice & Guidance via Consultant Connect, the haematologist reviewed the results and explained that the blood picture looked like Chronic Lymphocytic Leukaemia (CLL). He felt that a bone marrow biopsy would be the investigation of choice but that it might be too traumatic for the patient. We decided that, after discussions about the patient’s current physical health, investigations were not in their best interest. The CLL was likely to be very slow to escalate and, since the patient has a very stable quality of life, it was perfectly reasonable not to investigate further. This reassured me that I had really considered the pros and cons of whether to investigate or not. The haematologist was so helpful, we avoided a referral, and the patient maintained their quality of life. It enabled me to be part of the decision-making process, and this was important given the patient’s health.’
Head & Neck Cancer
‘I saw a patient who had been for a routine ultrasound on a thyroid lump. The report results indicated new nodules, but the grading system is not something I am familiar with interpreting, so I wasn’t sure if the nodules were suspicious. I forwarded the report and scan via the Suspected Head & Neck Cancer messaging line for advice. I received a response from Denise, who advised that I should make a 2WW referral and that she would book the patient in for a fine needle aspiration without needing a clinic appointment first. As a result, the patient’s care was fast-tracked, and they were put on the cancer pathway the same day, ensuring the patient got the care they needed fast. If I had seen the patient before having access to this line, I would have needed to call the hospital switchboard and find a specialist in Head & Neck Oncology or Radiology to review the report. It would’ve been complicated to locate the right person; this streamlines the process and makes it significantly easier
‘I had a patient return to the UK from Cyprus with an ultrasound scan (USS) report, and I wasn’t sure how to proceed. The scan showed some lumps on their thyroid, but they weren’t categorised using the British Thyroid Association’s (BTA) U classification. I thought the scan should be repeated, so I sent the report to the Head & Neck Cancer Team via Consultant Connect. After speaking with a Head & Neck Radiologist, the team replied that they weren’t concerned, so they advised repeating the scan locally and forwarding the new report if there were still questions. In a society where waiting times for specialty input are astronomical across the UK, that saved me from referring a patient to be seen in the clinic in a year just to be told to have a repeat scan, which was really helpful.’
Infectious Diseases
‘A patient presented in the surgery with a fever and feeling unwell after recent travel to Southeast Asia, and I was querying a diagnosis of typhoid. I wasn’t sure whether it was a condition that was managed as an outpatient or inpatient, and therefore, whether she could be a direct admission rather than going via medical assessment. I called the Infectious Diseases line via Consultant Connect, and a specialist answered immediately and advised that she required an admission via medical assessment. Before having access to this service, I would have needed to bleep a specialist via the hospital switchboard, which would’ve prevented me from carrying out other important tasks.’
‘I saw a patient who had recently travelled in an area where they may have caught an infectious disease, and I needed to know quickly whether that was the case so I could advise and treat them accordingly. The patient required a rapid blood test, which can be conducted in general practice. However, because of how the system operates, if we take the patient’s blood in the morning, the sample wouldn’t be collected until the early afternoon. In addition to that, the driver collecting the sample would likely also need to pick up samples from other GP practices before finally delivering the patient’s blood sample at the hospital, which can add another three hours to the timeframe. So, I used the Consultant Connect App to speak with an infectious diseases specialist who told me to send the patient in, and they would conduct the investigation there and then. It was such a quick method of communication and it’s great to connect with experienced colleagues.’
Mental Health
‘A GP contacted me about the management of a complex psychotropic medication regimen and akathisia in a young man. The patient was taking Aripiprazole which he started for psychosis when using large amounts of illicit drugs. He was also taking Venlafaxine with different daily doses and possibly Quetiapine. Additionally, he was on Procyclidine, Insulin and Ramipril. His diagnosis was anxiety and antisocial personality disorder, ADHD as a child and illicit substance use. The patient had rung the surgery as he was concerned about his jumpy legs and feeling twitchy (akathisia), which had been ongoing since he came off using street drugs some 4-5 months previously. The patient had been adjusting his medication – taking Quetiapine on and off every few days. I recommended finding out the rationale for how and why the patient was on two antipsychotics and informed the GP that Procyclidine does not treat akathisia and can be abused. Since the patient had a history of substance misuse and Procyclidine can cause euphoria, I advised him to reduce the dose to 5mg daily for one week and then stop. Aripiprazole can also cause akathisia, so I suggested withdrawal by reducing the dose to 10mg weekly to stop. I also advised that the patient may stop abruptly as the long half-life of this drug means it takes two weeks to be removed from the body after stopping. The GP wanted detailed advice on managing the patient so she did not have to re-prescribe Benzodiazepines. The management plan was initiated, and this was a great result for both the GP, who got the advice she needed quickly and efficiently and the patient as a clear and thorough plan was constructed.’
‘I was called by a GP who had a patient with depression. The patient was taking Sertraline but wanted to switch back to Mirtazapine because it helped them to sleep better. However, the GP was unsure how to handle the switching of medications. I spoke to the GP, and together, we formulated a switching regime that was appropriate for the patient. This was a great result as the patient received rapid results and the best possible care. In this case, Telephone Advice & Guidance was important as the GP received rapid support when needed, and the patient remained in the community.’
‘I recently received a call from a patient’s mum who stated that the patient was expressing suicidal thoughts, which had happened previously. Their mum was really worried, and the call came through towards the end of the day, so I needed rapid advice. I called the MHAU line via Consultant Connect and discussed the patient with the specialist, and we quickly devised a patient management plan. The specialist advised me on actions to take in the interim as well as a follow-up plan for later down the line. As a result of this call, I was able to give the patient and their mum a definitive plan which they were happy with, and the prompt response put them at ease.’
Neurology
‘A young female presented with left-sided numbness and weakness affecting her face, arm, and leg. She had been seen in hospital and a transient ischaemic attack (TIA) was considered, but various tests, including a CT, were negative. Her GP had requested a brain MRI, which showed a partially empty sella (pituitary fossa) and wanted advice on these findings. The GP called me via Consultant Connect and we discussed the nature of the patient’s symptoms, and I advised on an urgent referral to neurology; however, as urgent referrals in the patient’s area could take in excess of 6-9 months, I advised an urgent optician’s assessment to look at optic discs and visual fields, referring onwards as necessary. I also explained the need for certain lifestyle measures, to avoid the risk of stroke, and directed the GP towards relevant patient literature.’
‘I saw a 45-year-old patient suffering with cluster headaches. He was already on the Neurology waiting list but was struggling to function due to the pain. I used Telephone Advice & Guidance to speak with a specialist colleague in Neurology for immediate advice and to discuss a patient management plan. I was able to call the patient back straight away with an update and a different analgesic option, for which the patient was very appreciative. Using Telephone Advice & Guidance in this way meant that I could get a prompt response and set out a clear management plan whilst the patient waited for his outpatient appointment.’
‘I sent a message via the Consultant Connect App to a consultant neurologist on the NCN after seeing a patient with a neurological concern. The consultant assured me that the patient was suitable for a 40-week referral rather than an urgent one.The response was rapid, and I was able to reassure the anxious patient and put them at ease quickly.’
Ophthalmology
‘A patient suffering from chronic eyelid dermatitis contacted me. Unfortunately, his usual treatment regime was not alleviating his symptoms, so I used Consultant Connect to call a specialist for Advice & Guidance. I found the entire procedure very beneficial as it provided immediate access to advice, and my call was answered within seconds. It was helpful to talk through the patient scenario with an expert clinician. In this case, I was connected to a hospital optometrist, and an ophthalmologist was present. Together, they gave me a clear treatment regime to relay to my patient.’
‘There was a patient for whom I think the service worked really well. It was a 34-year-old male who had a corneal issue on one of his eyes, but because of his learning difficulties, he couldn’t quite communicate the discomfort he experienced. I took a photo and sent it over to the triage team at University Hospitals of Coventry and Warwickshire NHS Trust. I received a prompt response advising that it could be something that needed treatment straightaway. That patient was seen within 24 hours. My patients are aware of the service and have appreciated it.’
Orthodontics
‘As a dentist with a special interest in orthodontics, I often send Advice & Guidance queries relating to patient treatment plans. I’ll also send through queries for advice relating to the extraction of deciduous teeth, for example.
In these cases, I’ll ask the specialist if they think it is appropriate to take this deciduous tooth out early to try and promote eruption of another.’
‘In general, the service is of huge benefit to patients. Being able to advise on orthodontic treatment plans means the DWSI can start certain cases much sooner. Because of recent pressures, the patients would have been waiting probably a year to 18 months before being assessed by us. A general example recently was a dentist sending in a photo of a patient with an extra tooth in the palate, behind the front teeth. I advised the dentist to remove the tooth, which saved the patient from needing to be referred in and waiting a long time to see us. It also saves on the expense of time and travelling and reducing elective care long waits.’
Orthopaedics
‘Over the last 12 months, a patient from our practice attended the emergency department due to foot pain. The patient had an x-ray which confirmed that a bone wasn’t broken and was discharged from the emergency department.
A short time later, the patient returned to the practice with the same issue. The x-ray report identified the possibility of a foreign body in the foot and rather than sending the patient back to the emergency department, Consultant Connect was used to speak directly with a specialist.
The consultant was able to review the images and quickly organised a repeat x-ray and follow up appointment for the patient. Without Consultant Connect, the patient would have had to go back to the emergency department and would have had to wait to be seen. Going direct to a pre-arranged appointment with a specialist made best use of both patient and hospital time. This meant the patient received the care and treatment they needed in a more streamlined and effective way.’
Paediatrics
‘I recently saw an unwell baby with low oxygen saturation. He had a slight cold, the patient’s mum was worried, and the examination was largely uninformative, apart from an oxygen saturation of 82%. I tried different oximeters, but the saturations were still low. I used Telephone Advice & Guidance via Consultant Connect to get specialist advice. I discussed my findings with a consultant paediatrician, who immediately advised that the patient be admitted. The patient was in hospital for four days and treated for the infection onsite. Apart from the low saturations, the patient’s presentation was normal. Using Telephone Advice & Guidance that day was crucial. If I hadn’t had the conversation with the specialist, the patient would likely have been admitted due to a 999 call later that day.’
‘I recently answered a call via the outpatient advice line. The patient was a young child who had recently moved from a different country. The child had a rare metabolic disease. The child had been under follow-up in his country of origin, and the GP was wondering how best to get him into follow-up within our services. I was able to point the GP and child to the relevant specialists within our health board who had experience in dealing with these rare metabolic conditions. This enabled the GP to refer the child immediately to the right place, avoiding a referral to a general paediatrician (who may not have experience with this rare condition).’
‘I answered a call from a GP who was worried about a paediatric patient having frequent seizures and possible epilepsy. The patient had an appointment for an EEG test to look for epilepsy, but their appointment wasn’t due for a while. The GP wanted to know if we could expedite the appointment so that the child could be seen by us within a few days of having the test. As a result, the query was answered quickly – they didn’t need to send a letter and await a response from the consultant or administrator. This meant they could advise the patient and their parents quickly and the appointment with the Paediatrics Team was scheduled after the EEG test.’
‘I recently saw a three-year-old child in practice with a urine infection. However, mid-way through the consultation, they became very distressed, complaining of neck pain. I was concerned as to what could be the cause and decided to utilise the Paediatrics Professional-to-Professional Advice line via the Consultant Connect App. A paediatric consultant answered immediately, and agreed that this was unusual and advised the patient and their parent to attend A&E for further assessment. It was so reassuring to have specialist advice and a second opinion so quickly. The consultants are extremely helpful and supportive, which has been a huge help when seeing young patients and their worried parents in the community.’
Palliative Care
‘I recently contacted the Palliative Care Team for advice on managing an end-of-life patient. I spoke with the specialist very quickly to discuss a treatment plan that allowed the patient to remain comfortable at home with their family around them, rather than going to hospital. The Consultant Connect App provided easier access to communicate with specialist teams, and this has been really helpful as the procedures have regularly changed through different stages of the pandemic.
Patient Connect
An elderly female patient in a nursing home had a fall, which resulted in a scalp wound. The wound had been managed by a staff nurse on site with steristrips but the wound needed further treatment. The nurse had phoned NHS 111 and been directed to the Flow Navigation Hub and told to wait for a call via Patient Connect. Dr Andrew Russell, an A&E consultant at University Hospital Monklands then phoned the nurse to discuss via Patient Connect. The patient would have required ambulance transfer both to and from hospital, so Dr Russell phoned the out-of-hours hub to get the number for the area district nurse.
Podiatry
A patient with a swollen and painful foot contacted his GP. The GP asked him to send in some pictures. These images and the patient’s history were uploaded to the Consultant Connect platform and shared with a specialist.
The GP and the consultant were able to decide on a full management plan with different steps which was shared with the patient. The GP and the patient have started actioning this. The consultant also asked to be kept updated so he could provide further advice as needed.
This was a good result for both doctors and the patient as it meant that the patient could remain in primary care.
Radiology
‘A female patient who had recently suffered weight loss came to visit me. I examined the patient and found an enlarged liver. Urgent blood tests showed deranged liver function and raised ovarian tumour markers. The patient had a history of breast cancer and had been discharged a year ago. Clinically, the patient had suspected metastases from an unknown primary, and I was worried about the potential delay that could happen to her investigations during COVID-19. I used Consultant Connect to speak to a local radiologist to discuss the patient’s symptoms and arranged for her to get an urgent CT TAP scan in the same week. The scan results showed multiple metastases secondary to breast cancer. I was able to promptly refer the patient to the oncology team, where the patient was assessed for palliative chemotherapy within two weeks of being seen in primary care. The patient was very grateful for the speedy way in which she was managed.’
Respiratory Medicine
‘On another occasion, I saw a patient with troubling asthma. The patient was having repeated exacerbations, which were not improving. I used Consultant Connect to speak with a respiratory consultant to receive advice on the correct treatment plan for the patient. I received a rapid response from the specialist. The consultant I spoke to offered immediate treatment advice and the next steps for the patient if the treatment was unsuccessful.’
‘A patient experiencing rapidly worsening shortness of breath over the last few months came to see me, and I initially diagnosed pulmonary fibrosis. The patient didn’t require an admission but could not have waited months to be seen in a Respiratory clinic. I used Consultant Connect to rapidly speak to a local respiratory specialist at the University Hospitals of Dorset NHS Foundation Trust. By speaking to a specialist, the patient avoided an acute admission as the specialist arranged an outpatient appointment within a few weeks, with necessary investigations carried out beforehand. The patient was happy they were being seen by a specialist urgently.’
‘I recently received a call regarding a patient experiencing breathlessness and low oxygen levels. The patient had also recently been discharged from hospital, and the paperwork suggested that readmission was not advised. Additionally, the patient wished to remain at home. I provided advice to support the patient’s care in the community in accordance with their wishes by adding a tablet-based treatment to their regime and organising an assessment the following day. Collaboratively, the GP and I started a similar management to a hospital setting via support from the Community Respiratory Team. I felt we offered patient-centred care whilst sharing perceived clinical risk.’
‘I recently saw a patient who had been under the care of specialists for many months with chest infections and breathing problems, and she had tried various medications and antibiotics. When I saw this patient, she had already been referred to the Respiratory Team at Medway NHS Foundation Trust, but she was experiencing the same symptoms so booked a GP appointment. The patient was off sick from work, fed up that she couldn’t sleep or walk due to breathing issues, and frustrated that the medical interventions were not having any effect on her condition. She was advised that there was currently an eight-month wait to be seen by the Respiratory Team but wanted to know if there was anything else that could be done in the meantime. I used Consultant Connect to call a local respiratory consultant who was extremely helpful. He looked at her previous history and scans, and suggested a steroid and different inhaler that could be prescribed in the interim. He also advised that he would ask the secretary to expedite the patient’s appointment as she was most likely suffering from long Covid. After prescribing the steroid and inhaler, I followed up with the patient two weeks later. She was like a completely different person. Her life had changed dramatically; she was going for walks, sleeping better, and considering going back to work. Although her appointment with the Respiratory Team had been expedited, she wasn’t as concerned as before because she felt such a difference. She was so thankful for the specialist advice, which allowed her to get the care she needed fast, and I found it a truly rewarding experience.’
Rheumatology
‘I spoke to a rheumatology consultant at my local Trust. The consultant reviewed the blood results and confirmed a likely diagnosis of rheumatoid arthritis and advised they would most likely give a Depomedrone injection and then consider DMARD. Speaking to the consultant made me feel confident to continue to support the patient and his wife, and meant they knew what was likely to happen. They had a chance to read preparatory patient information so could make an informed decision regarding starting a DMARD in that first outpatient appointment. It was easy to get through, and a few minutes on the phone meant that we could work in an integrated way across primary and secondary care. Together we were able to deliver good quality care to this vulnerable patient.’
‘I saw an elderly gentleman with symptoms suggestive of polymyalgia rheumatica, however it was an atypical presentation and I was concerned that I might be missing something (such as underlying cancer) and was not sure whether to initiate treatment or wait for further tests or refer, knowing that a referral could take several weeks. I called the Rheumatology Team via the Consultant Connect App and was able to discuss the case in detail with the senior registrar who advised me what tests to organise and when to initiate treatment, as well as a detailed steroid reducing regime. The registrar explained all the things that would have been arranged at the first clinic appointment, so I was able to get the ball rolling before the patient would be able to be seen at the clinic. This was a better outcome for the patient who was able to get the right treatment quickly.’
A patient presented to Dr Francis with symptoms suggesting Giant Cell Arteritis. Dr Francis was able to use immediate Telephone Advice & Guidance on the Consultant Connect App to speak to a local rheumatologist at University Hospitals Dorset. The consultant advised on the best course of action. Dr Francis commented that he ‘can highly recommend’ using this service.
‘Speaking to a consultant was an excellent, direct, and time-saving way to access timely consultant advice. Using the app is the easiest way to speak to a specialist consultant I have yet to find.’
Dr Francis also explained that he called Rheumatology again a week later. This ensured that the patient had a timely clinic review to consider a temporal artery biopsy. This was a positive result as Telephone Advice & Guidance allowed the patient to get quick and effective care.
‘A patient presented with severe symptoms of back pain, knee pain with effusion, ankle pain and clear evidence of synovitis. The presentation was of an acute flare-up of probable seronegative arthritis. The patient had already been referred to Rheumatology and was awaiting an outpatient appointment, but their condition had clearly deteriorated significantly and rapidly. As a result, the patient was in a lot of pain, could barely mobilise and was in significant distress. I spoke with an out-of-area NHS Consultant Rheumatologist for advice. With the current Covid-19 climate, I wanted to avoid an admission for the patient if feasible, so it was helpful to be able to discuss my plan to treat the patient’s condition with a consultant and their reassurance meant that an admission was not necessary. Using Telephone Advice & Guidance was reassuring for me and gave me the confidence that I was making the best decision. The patient was relieved that they didn’t need to be admitted to hospital.’
‘I saw a patient whose blood tests came back showing very high levels of transaminases as part of his liver function blood test monitoring on methotrexate. The level of transaminases was just above the level at which specialist advice was recommended in order to decide if methotrexate should be temporarily stopped. Previously, I would have had to call the hospital. However, I was able to get through to a rheumatologist via Consultant Connect, who confirmed that it was best to omit the dose for that week and repeat the liver function blood test the following week. This was especially helpful as the patient was very reluctant to stop his methotrexate, so being able to provide timely specialist advice and reassurance was particularly important for him. She also discussed the best ongoing management with respect to the repeat transaminase levels, which was very useful.’
‘A patient presented with intermittent random swelling to her fingers for the past 15 years, which she noticed started happening after the birth of her youngest child. At the time, she was seen by a vascular specialist who conducted scans, which were reported as unremarkable. She came to see us last week because her finger had swelled four times in 24 hours, which was even more unusual. She was understandably worried because it was blue in colour and throbbed. With the patient’s consent, I used Consultant Connect to take and send her photos and clinical history to a rheumatology specialist. The consultant replied, saying that she suffered from the same condition, known as Achenbach’s syndrome, and that the patient didn’t need any treatment. I had never heard of this condition before, but I was so surprised at the quickness of the reply, which came through within an hour of the initial message. For the patient, it was reassuring that it was nothing sinister and she was so grateful.’
SDEC
‘I had a gentleman who had been back and forth to see me with very vague symptoms: a fever, rash, pain and feeling generally unwell. His bloods weren’t matching a pattern that was consistent with his presentation. I treated him on a few occasions, and he would improve slightly and then decline. It was very strange and had continued for weeks. I called the medical SDEC line via Consultant Connect and discussed the patient with a consultant. I explained that the patient’s ferritin level was raised, and his hands were swollen; it looked rheumatological, but I didn’t have an answer. The consultant suggested I take some swabs, repeat the patient’s bloods, prescribe another course of antibiotics, and, in the meantime, send an urgent referral to infectious diseases. Within 20 minutes of that call, the consultant had phoned back to say he had spoken with a colleague, and they thought it could be stills disease. This is a rare condition, similar to adult-onset juvenile arthritis, and this diagnosis fit with the patient’s previous blood tests. The consultant advised that he had booked the patient for an urgent appointment with a practitioner specialising in diagnostic uncertainty the following day. The patient had an Echocardiogram, CT, blood cultures and an appointment, all within 48 hours of the phone call. At the patient’s outpatient appointment, they ruled out a lot of very serious disorders, such as sepsis, endocarditis, and other autoimmune conditions, and he was then referred to rheumatology. The patient wrote to me within a week to give me a complete update and to advise that he was exceptionally happy with his level of care.’
Spinal Issues
‘I saw a 55-year-old patient who had recent onset acute lower back pain. During the telephone consultation, I identified red flags in their history which suggested the patient may have Cauda Equina Syndrome and needed an urgent MRI scan. I contacted the Spinal Team via Consultant Connect and was instantly connected with a consultant orthopaedic spinal surgeon. He agreed that the patient required an urgent MRI of their spine and gave me advice on how best to arrange this via our local A&E department. I arranged admission of the patient to A&E with a referral letter which included the details of the consultant’s advice I received. The patient had an MRI scan which fortunately showed only a slipped disc, excluding Cauda Equina Syndrome. The patient was discharged from A&E later the same day with analgesia. I followed up the patient afterwards, and they were very grateful for how quickly their problem had been assessed and managed, and this was only made possible with the help of Consultant Connect.’
Stroke
‘I saw a patient who had had a stroke and was taking apixaban and statin. They recently had their bloods taken, and their liver function test (LFT) was grossly abnormal, which was a new finding. I sent a message to a haematology consultant, who reassured me that the patient could be managed locally and that a referral was unnecessary. This was excellent for the patient as they didn’t need to travel to the hospital and wait to speak to a clinician in Secondary Care.’
Trauma and Orthopaedics
‘I received a call from a GP regarding an elderly patient with a soft tissue swelling in the thigh and a history of minor trauma, which the patient had assumed was a muscle sprain. The lump was getting bigger despite rest. This was a typical but rare case of soft tissue/muscle sarcoma. I advised the GP to urgently refer the patient via their local two-week-wait pathway (2WW) to the Musculoskeletal (MSK) Tumour Service. This meant the patient’s care was expedited, and they got the correct care faster.’
‘Over the last 12 months, a patient from our practice attended the emergency department due to foot pain. The patient had an x-ray, which confirmed that the bone was not broken and was discharged. A short time later, the patient returned to the practice with the same issue. The x-ray report identified the possibility of a foreign body in the foot, and rather than sending the patient back to the emergency department, I used Consultant Connect to speak directly with a specialist. The specialist reviewed the x-ray images and quickly organised a repeat scan and follow-up appointment for the patient. Without Consultant Connect, the patient would have needed to return to the emergency department and would have waited a long time to be seen. Going directly to a pre-arranged appointment with a specialist made the best use of both patient and hospital time. This meant the patient received the care and treatment they needed in a more streamlined and effective way.’
Urology
‘On one occasion, I saw a patient’s ultrasound scan showing an incidental finding of a renal cyst. I used Consultant Connect to speak with a consultant urologist to discuss the best course of action. The consultant recommended that I organise a CT scan and that the patient’s cyst be continuously monitored using further ultrasound scans.’
Vascular Surgery
‘I suspected a patient was developing peripheral vascular disease but wasn’t entirely sure. Measurements at the surgery had been done and were suspicious, so I wanted to order further investigations but wasn’t sure which or if an admission was needed. I used the free Consultant Connect App to contact the Vascular Surgical Team, who suggested that they would conduct all necessary investigations in one clinic. This meant an admission wasn’t needed unless the patient’s condition worsened and a routine clinic referral was made. The patient avoided an unnecessary admission and had a more convenient all-encompassing appointment which confirmed the diagnosis. The patient was happy not to have been admitted to hospital.’
‘A patient attended the podiatry clinic in the community for a review but was found to have deteriorated significantly. The podiatrist securely uploaded clinical photographs with the patient’s consent and added a brief history. The images were reviewed, and the patient was transferred urgently to the Vascular Team at UHCW. This was all done via Consultant Connect. Without this service, the patient would have likely been sent to South Warwickshire NHS Foundation Trust for an assessment and then transferred to UHCW, but by sending the images for analysis, we bypassed that completely. The fact that the patient was seen so quickly and efficiently is particularly important as they had an ischaemic foot, which is a vascular emergency.’
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