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Feature: eConsult explains how digital triage can support the NHS backlog

Feature by eConsult

As part of our ‘digital first’ focus this month, eConsult, an online triage and remote consultation provider, tells HTN how digital solutions can help with the NHS recovery and specifically how the use of intelligent digital triage across the NHS can support the growing backlog of patients awaiting care.

The company shared with us its reach, latest use cases and how it’s supporting healthcare providers…

eConsult is the NHS’s largest digital triage provider, supporting healthcare professionals to identify patients most in need of care so that they are seen by the right person, at the right time and in the right place. In primary care, over 1 million eConsults are submitted on a monthly basis.

During the pandemic, with the mandate from the NHS for primary care to implement ‘total triage’, the number of GP practices using eConsult doubled to over 3,000 in just six weeks. GP practices also heavily increased their reliance on online consultation tools and remote consultation technology, such as video and telephone consultations.

However, primary care is not the only sector of the NHS that has started to explore how digital-first options can support them, with a growing number of hospital trusts tapping into eConsult’s triage and remote consultation expertise.

Since the pandemic started, eight Urgent and Emergency Care sites have started using eConsult’s digital check-in and automated triage technology, with others being onboarded now. This technology allows sites to collect more information about patients within minutes of them arriving in order to facilitate triage.

Not only that, but they are able to screen patients for COVID symptoms quickly. Based on this information and the clinical acuity of the patient, clinicians are therefore better able to identify patients suitable for redirection, relieving pressure on staff and waiting times, and decompressing the waiting room.

Dr Murray Ellender, GP, CEO and Co-founder of eConsult, added: “Improving the ability to triage patient needs is going to be fundamental to the NHS clearing not only the backlog but becoming more sustainable, especially considering the workforce and budget constraints that we are unfortunately dealing with.

“In A&E, your front line staff do triage every day, but triage can be inconsistent depending on seniority and level of training. In outpatient departments, and in primary care, patients are still often seen on a first-come, first-serve basis.”

“In those settings, there’s no meaningful triage because you’re not collecting enough information about the patient upfront. That means you can’t easily assess who needs help now and who can be helped later or even somewhere more appropriate. The ability to prioritise the patients that need help quickly the most is crucial, and that’s where technology can support, not replace, decision making.”

“You want that rich information straight from the patient, and in an easy to digest format. We’ve developed question sets across the NHS, which are used to gather all the information the receptionist or clinician would usually ask a patient for.”

“Having that information upfront is what allows extremely efficient triage. Based on that information, patients can be prioritised effectively. The fantastic thing for staff is that you’re collecting that information asynchronously in the patient’s own time, not the clinician’s.”

The COVID-19 pandemic has accelerated the use of technology to support patient care. There have been both benefits and challenges realised during the past 18 months and, whilst a return to pre-pandemic normal is unlikely, there is a real opportunity for the NHS to rethink how it delivers some of its services.

Whilst the news recently is full of debate about how primary care services are delivered, in particular with heavy debate about patient preferences, headlines are also shining a light on the full extent of the waiting lists hospitals are currently trying to tackle, with patients sometimes unable to use NHS services as they did previously.

Digital First in Secondary Care isnt just about video consultations

The BMA estimates that, between April 2020 and August 2021, there were 26.78 million fewer outpatient attendances. With nearly 6 million people currently waiting for hospital treatment, the highest number since records began, eConsult is continuing to work across the NHS to highlight the benefits of a digital-first approach that is supported by triage.

The outpatient department is an area that is going through a lot of change at the moment. The NHS Long Term Plan set an expectation for up to a third of the face to face appointments delivered in outpatient care to be avoided by 2024. This would save NHS England around £1.1 billion a year, as well as save patients 30 million visits to hospitals.

An analysis carried out in 2020 suggested that almost five million clinician hours could be saved if 30 per cent of outpatient appointments were moved to virtual consultations, and that £266 million could be saved by reducing ‘Do Not Attend’ rates for outpatient appointments to 2 per cent.

A dermatology department working with eConsult recently demonstrated a zero per cent DNA rate through the combined use of digital triage and remote consultations. The trust has been working with eConsult to co-develop their outpatient triage solution for a number of specialties, such as cardiology and hepatology.

The department is firstly triaging the needs of patients on their waiting list and then managing as many patients remotely as possible. To do this they have been using Q health, the combined telephony and video consultation platform developed by Q doctor, who eConsult acquired in early 2021.

Previous research in outpatient departments in Wales found that between 8.5 per cent and 15.7 per cent of clinicians reported challenges in their virtual consultations because of technical difficulties, such as poor audio or video quality, or problems with their internet or device.

Q health’s combined video/telephone functionality with one-click upgrade/downgrade means lower DNA rates than video alone. With two in five people in the UK not currently able to do video consultations, this flexible consulting modality is critical. The same activity carried out using Q health reaches more patients (those with poor connectivity, limited technical ability) and therefore allows the delivery of more successful remote consultations.

This unique feature increases clinic efficiency, as staff spend less time mitigating video calls with poor connections or re-dialing patients and entering phone numbers. If it would be clinically useful, it allows a clinician to upgrade a telephone call to video, knowing that the patient is supported in using an unfamiliar modality if they have been reassured by the clinician.

“So much of what we’re working on now is about refinement and improvement of existing processes in the NHS” says Murray. “We’re not trying to reinvent the wheel, but we think tweaks to the wheel can make it much more aerodynamic and faster.”

“Our whole ethos is to work with those within the NHS, like us, because collectively our expertise can make a difference – one in five of the eConsult team is clinical. That’s how our relationship with Q doctor started and then we realised it made sense to work as one and not just side by side.”

“We want to be the digital front door to the NHS and we know that many, not all, patients do want and feel comfortable with increasingly digital services. First and foremost is patient safety because as clinicians we’d never put patients in harm’s way.”

That’s one of the reasons that eConsult is currently offering outpatient departments a free trial of their Q health video and telephony platform. It was developed with the connectivity challenges facing departments and patients in mind, to reduce wasted time and improve the consultation experience.

When combined with digital triage, this end-to-end digital first approach could help to tackle the growing backlog of patients needing care, whilst continuing to keep the NHS going as the pandemic develops.