The effect of the introduction of NHS Direct on requests for telephone advice from an accident and emergency department2001; 18: 300-1
An analysis of calls referred to the emergency 999 service by NHS Direct 2001; 18: 302-4
Since the introduction of NHS Direct, incoming calls to one accident and emergency medicine (A&E) department have fallen by over 70 per cent, reports a study in Emergency Medicine Journal. But by the same token, the number of calls for medical advice received by the hospital switchboard soared by over 300 per cent. A second study in the same area also reports that the service has had very little impact on rising emergency admission levels.
An audit was made of incoming calls for medical advice to a district general hospital in Yorkshire before and after NHS Direct was introduced in April 1999.
In October 1998, the A&E department took 84 calls from the public, but a year later this had fallen to 23, a drop of almost 73 per cent. But a further 242 calls were redirected to NHS Direct in October 1999, representing an increase of 315 per cent over the previous year's calls to the hospital. Almost half the calls had been redirected from A&E. Attendances at A&E rose by over 5 per cent.
The authors comment that an average public call to A&E for medical advice takes almost four minutes. So the substantial reduction in calls, if reflected throughout the rest of the UK, could save around 90,000 hours of staff time a year. But equally, the surge in calls to the hospital would require an extra 390,000 hours of staff time, equivalent to 230 full time nurses.
A second study of 999 calls affecting three A&E departments in Leeds, Wakefield, and Pontefract, up to August 1999, showed that there was little difference in triage categories for patients who had self referred and those who had come through NHS Direct. This, say the authors, indicates that illness severity is equally well assessed by those who choose to ring 999 themselves.
Patients who made 999 calls themselves tended to be admitted and followed up, but say the authors, that most likely reflects their older age and seriousness of their condition rather than any other factors. Furthermore, the NHS Direct 999 referrals amounted only to a couple of patients a week seen in A&E, around 0.5 per cent of cases at the three departments. So if the stated aim of reducing the number of emergency attendances is to be reduced, they say, many more people would have to start using NHS Direct rather than dialling 999 themselves.
Dr Jonathan Jones, Department of Accident and Emergency Medicine, Leeds General Infirmary.
Tel: +44 (0)113 392 8909 or (0)113 275 8198 (H)
Dr Steven Crane, Accident and Emergency Department, Pinderfields Hospital, Wakefield.
Tel: +44 (0)1924 212 316 /mobile 0788 775 2029