44 Wirral's Teletriage Service

Introduction

The Wirral Teletriage Service provides non-urgent clinical support to Wirral Care Homes in order to help avoid unnecessary hospital admissions for their residents. It also aims to provide quicker access to clinical assessment than via NHS 111 and to provide this care in the patient’s residence wherever possible.

Methods

Care homes call the Teletriage service when they have concerns about the health of one of their residents. The Teletriage nurse undertakes a clinical assessment of the resident remotely via Skype. Care Homes have been provided with a secure NHS email address to facilitate secure sharing of data. They have also been provided with iPads and training for their staff. After being assessed by Teletriage, residents are signposted to the most appropriate care pathway for their needs.

Results

76 Care Homes have signed up to the service. On average, the Teletriage Service receives 300-400 calls a month. In an 18 month period, the number of calls to NHS 111 have reduced by 76%. Out of all the calls to Teletriage, 22% of patients were managed by the Teletriage team with no onward referral, 57% were managed via community services e.g GPs, Community Geriatricians, and 10% were referred to the ambulance service. Emergency Health Care Plans (EHCPs), Preferred Priorities of Care and EOL (End of Life) wishes are taken into account.

Conclusions

The Teletriage project has reduced the number of phone calls to NHS 111 and the ambulance service, and subsequently has reduced the number of patients conveyed to hospital by 12%. The Teletriage nurses work very closely with various community services as well as GPs, NWAS and Community Geriatricians. The ongoing training and education provided to the Care Home Staff means that overall there has been good engagement with the project from the majority of the Wirral Care Homes.

Urinary output during induced labour in normotensive women: a prospective pilot study

All fluid intake and urine output were monitored and measured in 103 consecutive women with normal blood pressure and without a history of pre-existing renal disease during induced labour for various indications. Epidural analgesia was administered in all these women and labour was augmented with oxytocin infusion. All urine specimens passed were tested for specific gravity. The temperature of the labour rooms was between 25 and 27 degrees C. Analysed results (from 50 women) shows that at a mean fluid intake of 75 ml/hour (standard deviation (SD) 21.84), oliguria (urine output <30 ml/hour) occurred in 42 (84%) of the women. There was a positive correlation between fluid intake and urinary output (r(2)=0.8515, P<0.0001). Urinary specific gravity was high (>1010) in all the specimens throughout the study. This study suggests that oliguria may be a common component of labour managed in this manner and its interpretation in pre-eclamptics in labour may be viewed in this context. Oliguria may therefore be a poor indicator of renal function or worsening pre-eclampsia during labour and its management needs to be limited to the severe and persistent variety to avoid renal complications. We believe from this study that relevant urine and blood biochemistry are better correlates of renal function in labour.

Parish registers and urban structure: the example of late-eighteenth century Liverpool

Readers of theYearbookmay readily ascertain from its register of research and bibliography that the energy applied to the urban history of Victorian England has not only been substantial but is far from expended. The attraction of huge amounts of raw material, both quantitative and literary, is difficult to resist. However, the challenge of seeking less solidly founded insights with the less abundant and more indirect sources of the eighteenth and early-nineteenth centuries has met with a far less enthusiastic response. In any case the sparseness of eighteenth-century sources is less stark than at first appears. Although by no means as reliable or as widely ramified in content as census data, Anglican parish registers offer considerable scope for anyone willful enough to resist the census honey pot. Particularly when supported by ancillary sources, such as maps and directories, they provide sufficient information for at least a tentative exploration of the beginning and unfolding of an urban process whose mature expression is revealed in the cornucopia of the middle-nineteenth century.