"The NHS Number You Have Dialed Is Busy. Please Die Later," UK

Main Category: Public Health
Article Date: 12 Jul 2008 - 0:00 PDT

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Nearly two thirds of NHS acute hospital switchboards fail to answer incoming calls within twenty seconds. The longest wait was 18 minutes. The average answering time across all switchboards was 45 seconds, and fifty hospitals took more than a minute on average.

These are the findings of a study published in the current issue of the Journal of the Royal Society of Medicine. The authors called 219 switchboards of all hospitals in England with an accident and emergency department.

The best performer was University Hospital North Durham (around 1 second) and the worst was Bristol Royal Infirmary (around 381 seconds). The authors found that automated answer systems substantially increased the answer time to an operator (the fastest automated service was at Princess Royal University Hospital - ranked 69th in the league table. They suggest that this may pass on unnecessary costs to the caller because of the lengthened call time.

A few Trusts have set their own targets, but there is no NHS-wide standard or audit system for the answering of hospital switchboards. The authors chose target response time of 20 seconds based on the target maximum response time of other organisations outside the NHS (e.g. police forces, borough councils and universities).

Hospital switchboard operators handle an extremely wide range of calls and both doctors and patients are heavily reliant on them. For doctors, these range from GPs or other hospital doctors referring patients with acute illness or trauma to specialists: hospital colleagues contacting one another to organise or find out results of scans, discuss patients, seek advice or find out who is on call. Patients call to find out about appointments or operations, or seek advice about their health problems, and relatives enquire about patients in hospital.

Operators also run the hospital emergency number for cardiac arrests, sending out emergency teams to any area of the hospital (over-riding all other calls), and run the hospital 'bleep' system. All these calls and activities are routed through the same switchboard.

Lead author Mr Kayvan Shokrollahi, a plastic surgeon recently awarded an honorary Professorship by the Royal College of Surgeons, commented, "NHS call operators do a fantastic job under difficult circumstances and are the lynch pin of many acute services. Yet too often they are poorly-resourced. If a service is not audited, standards can slip and we found that for call response times, there are no national standards in the first place. We assessed performance based on what we think is a reasonable standard but believe there should be a centrally-funded NHS-wide audit of switchboard response times, with findings published on a regular basis. If some hospitals can consistently answer their phones within one second, why can't all?

"I'm no great fan of league tables in general, but publishing such figures is a good way of putting this important issue on the map."

The authors made a total of 657 calls (at their own cost) over a one month period and at three specific timeslots on different days. The data measured answering times provided by human operators and answering services, and consistency of response.

"We undertook this study at our own expense to highlight the importance of the issue and we hope it leads to better resourcing of switchboards to take some of the pressure off operators. They do incredibly important work - often out of a dingy hospital basement. The switchboard staff are probably the only people in the entire hospital who can be relied upon to know who is on call for an emergency and how to get hold of them." said Mr Shokrollahi.

The authors believe the implications of slow response times include reduced efficiency in the NHS. "If a doctor is waiting for their call to be answered it is extremely frustrating - particularly when they are both tired and busy. But it also means that other patients are not being seen or treated." says Mr Shokrollahi. He goes on, "There is also a cost implication. Waiting on the end of an automated answer service costs more because callers are kept waiting after pick-up. Across the whole of the NHS in a year, that could add up to hundreds of thousands of pounds going straight to telecoms companies. What a waste!" Dr Kamran Abbasi, editor of the JRSM, says "Ara Darzi's NHS review has emphasised the importance of patients' perception of care, and waiting anything longer than a few seconds before you can speak to somebody at an acute hospital has to be a bad start.

"Interestingly, it appears that automated systems may be counter-productive by adding to costs and increasing delays. As hospitals increasingly compete with each other, indicators like switchboard response times will influence patient choice."

Notes

Please mention the Journal in your copy. Many thanks.

Mr Kayvan Shokrollahi is available for comment.

'How fast is fast enough? An audit and league table of response times of acute NHS Trust switchboards in England' is published in the July issue of the Journal of the Royal Medical Society, volume 101.

The JRSM is the flagship journal of the Royal Society of Medicine. It has full editorial independence of the RSM. It has been published continuously since 1809.

Its Editor is Dr Kamran Abbasi.

Royal Society of Medicine