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- Page navigation anchor for Predicting clinical deterioration after initial assessment in out-of-hours primary carePredicting clinical deterioration after initial assessment in out-of-hours primary care
As GPs with collectively 28 years’ experience of working in the Oxfordshire out-of-hours (OOH) service, we were interested to read the article on prediction of deterioration after initial contact with the service.
The results do not justify the conclusion that 'older patients, prior users of the service, and those presenting during less busy times, might benefit from active follow-up by the OOH service'. This would place considerable additional workload on the service. Before implementing such active follow-up by OOH clinicians, more evidence is needed: does it improve patient outcomes? Is it cost effective? Are there associated harms? Which specific clinical problems are most at risk? What is the best time frame for follow-up?
The authors seem to assume that delayed escalation to secondary care is a bad outcome. However, referral to secondary care may not have been appropriate at the first contact, or the patient may not have agreed to it. Although the authors state that 68.5% of those who required escalation were initially discharged with no follow-up, the coding system they analysed does not capture safety-netting advice given to patients, which is normally recorded in the free text of the consultation notes. The vast majority of patients receive safety-netting advice, which is the most appropriate way to manage risk and uncertainty in the OOH setting.
Over the 2016–2017 Christmas and New Year period, the number of patient contacts incr...
Show MoreCompeting Interests: We both work as GPs for the Oxfordshire Out of Hours service