Key Points

• Leading innovation on national and international projects
• Service redesign
• Robust Clinical Governance
• Daring to challenge
• Working across boundaries collaboratively
• Technical and clinical expertise

NHS 111 replaced the NHS Direct telephone advice service in England in 2014. Clinical Solutions International Ltd was NHS Direct’s technology and clinical decision support content supplier since it’s early days.

As Chief Medical Officer and Executive Vice President of Clinical Solutions, Dr Jean Challiner challenged the Department of Health’s mandate on an alternative clinical content and demonstrated to the Department, over a period of several months, that the Clinical Solutions clinical content or “Teleguides" were both safe and effective. The Teleguides became the only clinical content approved by the Department of Health for use within the NHS 111 service apart from the NHS's own content.

“I had the good fortune to work with Dr. Challiner on a number of projects involving clinical telephonic triage.  Few of the projects I have dealt with in my experiences spanning two decades of specialising in clinical/telephonic triage have included the scope, magnitude, and complexity of the project mentioned in this case study. This project did not only require a comprehensive clinical knowledge base, but also entailed a great deal of skill in teamwork, change management, leadership, and a commitment to the ultimate goal of adapting an existing clinical triage set.  The conversion encompassed a significant paradigm shift in the way telephonic clinical triage was delivered at the time. Dr. Challiner managed this process from start to finish with confidence, and a focused, task-orientated approach.  She very successfully completed and implemented the solution.” Dr. Conrad Fivaz MBChB; MMed FamMed, Chair of the ECNS Council of Standards.

Dr Challiner worked directly with the Department of Health representatives and with colleagues from Priority Dispatch Corporation Ltd (PDC) demonstrating the safety and effectiveness of the Clinical Solutions Teleguides. This included:

• Provision of a detailed history about the creation of the content and its subsequent development and use. 
• NHS and independent sector case studies from customers of Clinical Solutions and PDC
• Provision of evidence of the robust clinical governance processes which existed to assure both UK an overseas customers of currency, validity and evidence base for the Teleguides
• Setting up a new joint clinical project team across Clinical Solutions, Priority Dispatch and the International Academies of Emergency Dispatch (IAED) to: 
  • capture and integrate Ambulance sector experience with the Teleguides
  • take part in proactive risk assessment activities
  • configure the emergency sections of appropriate algorithms to ensure suitability for use by non-clinicians
  • determine which symptoms would be too high a risk for non-clinician assessment
  • streamline care advice to ensure a non-clinician was presented with the most appropriate care advice for the scenario described
  • identify the characteristics of and location of care required
• Technical development to ensure that a non-clinician was unable to stray into the clinical sections of the algorithm and that hand over to a clinician was dynamic
• Live demonstration of the content against test scenarios 
• Set up and delivery of 2 successful live pilots 
  • technical set up
  • training
  • supervision
  • call review 
  • data analysis

As a result of the content and software development work for this project, together with the robust clinical governance that was applied, Clinical Solutions  secured additional business across the world. The content and its underpinning Clinical Governance Framework have been accredited by URAC in the US and The Information Standard in the UK as a result of Dr Challiner’s work.