Responding to WAST / paramedic requests for a GP review a patient who has fallen for a "long lie" and undertake blood tests
We understand that GPs and families have on occasion been informed by Welsh Ambulance Service NHS Trust (WAST) / paramedics that patients who have had falls and cannot be attended by an ambulance for several hours should be reviewed by a GP for assessment and urgent blood tests. This raises inappropriate expectations and understandably causes frustration and concern when GP practices do not undertake an assessment or blood test. If WAST decide not to transport the patient to hospital but feel the patient requires a blood test, it is WAST's responsibility to organise these and follow up the results.
On a purely practical level if GPs were to arrange urgent bloods, the lag between a GP requesting them and receiving the results would render them useless due to GPs not having an emergency status.
We have had confirmation from Andy Swinburn (Chief Clinical Officer at WAST) that assessment and bloods for these patients are not the GP's responsibility and that a clinical bulletin has be issued across the organisation which states that:
"Clinical Notice: Updated JRCALC Guidance on Falls in Older Adults
This clinical notice is for the attention of all clinical staff involved in the assessment and management of patients following a fall, including remote care and face to face response colleagues.
The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) has updated its guidance on Falls in Older Adults, which includes a risk stratification tool. Within this framework, a long lie is classified as a medium-risk factor, recognising that the potential complications associated with prolonged immobility can vary considerably depending on the individual patient and the specific circumstances of the fall.
As such, consideration of long lie complications should be informed by a thorough holistic assessment, taking account of the patient's clinical presentation, co-morbidities, degree of mobility whilst on the floor, and any additional risk factors identified during assessment.
Please see the link at the end of this bulletin for further information.
The updated guidance is explicit that patients who have experienced a long lie should not be routinely conveyed to the Emergency Department solely for the purpose of obtaining blood tests.
Where concerns exist regarding the potential complications of a long lie, clinicians should not contact a patient's GP or other community services to request diagnostic blood tests including "long lie bloods". Consultation, escalation, and referral should instead be based on the findings of a holistic clinical assessment and identified clinical risks. The responsibility for determining the need for and arranging any diagnostic blood tests rests with the service accepting the referral.
Clinicians are encouraged to utilise available support and care navigation pathways to support collaborative decision-making and identify the most appropriate patient pathway, including:
Single Point of Access (SPoA)
Urgent Community Response (UCR) Services
APPNav
Clinical Navigators
Relevant Consultant Connect pathways
General Practitioners (GPs)
We thank you for your support of this clinical notice and your continued commitment to ensuring our patients receive safe, effective, and appropriate care. This notice has been developed to support clinical decision-making and help ensure patients receive the most appropriate care, in the right place, at the right time.
Please follow the link for more information: https://nhswales365-my.sharepoint.com/personal/ben_scott2_wales_nhs_uk/Documents/Longlie/Longlie/Addtional%20Information%20-%20Clinical%20Notice%20Long%20lie%20management.docx"
Please do get in touch if you have any concerns or queries regarding this.