Sebastian Hibberd
11 Jun 2019 · Coroner Ian Arrow · Plymouth, Torbay and South Devon
The coroner's concerns
1. inadequate recognition of acutely unwell children by 111 call handlers
“without changes in the NHS Pathways the 111 call handlers will not be adequately assisted by the Pathways to recognise the acutely unwell child”
2. absence of assessment for cold extremities in pediatric triage
“no question within the NHS Pathways questionnaire concerning cold hands and feet for children aged over five”
3. inadequate escalation pathway for non-clinician advisors
“no indication NHS Pathways/NHS Digital have reviewed the support arrangements for non-clinically qualified call advisors to refer unusual cases to clinically qualified colleagues”
4. inadequate pain assessment in paediatric triage
“NHS Pathways' questions did not allow a meaningful assessment of pain in a child”
5. delayed face-to-face assessment for repeated health concerns
“three contacts with medical providers about one concern should instigate a face to face meeting between patient and clinician”
Responses
2019-0193-Response-by-NHS-Digital.pdf ↗· NHS Digital
Stated action · 2 October 2017
“Historically, a question about whether a child has cold hands and/or feet has not been included within NHS Pathways. This was a deliberate decision not to include it after consideration of the available evidence of its accuracy as a discriminator of severe illness in a remote assessment setting. According to the National Institute for Health and Care Excellence (NICE) guideline for sepsis NG51, published in July 2016, cold hands and/or feet in the context of an unwell child is a moderate to high”