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Maintaining clinical governance when giving telephone advice
  1. William Alazawi1,2,
  2. Kosh Agarwal1,
  3. Abid Suddle1,
  4. Varuna Aluvihare1,
  5. Michael A Heneghan1
  1. 1Institute of Liver Studies, King's College London Medical School at King's College Hospital, London, UK
  2. 2The Blizard Institute, Queen Mary, University of London, London, UK
  1. Correspondence to Dr Michael A Heneghan, Institute of Liver Studies, King's College London Medical School at King's College Hospital, Bessemer Road, London SE5 9RS, UK; michael.heneghan{at}


Objective Delivering excellent healthcare depends on accurate communication between professionals who may be in different locations. Frequently, the first point of contact with the liver unit at King's College Hospital (KCH) is through a telephone call to a specialist registrar or liver fellow, for whom no case notes are available in which to record information. The aim of this study was to improve the clinical governance of telephone referrals and to generate contemporaneous records that could be easily retrieved and audited.

Design An electronic database for telephone referrals and advice was designed and made securely available to registrars in our unit.

Setting Service development in a tertiary liver centre that receives referrals from across the UK and Europe.

Main outcome measures Demographic and clinical data were recorded prospectively and analysed retrospectively.

Results Data from 350 calls were entered during 5 months. The information included the nature and origin of the call (200 from 75 different institutions), disease burden and severity of disease among the patients discussed with KCH, and outcome of the call. The majority of cases were discussed with consultants or arrangements were made for formal review at KCH.

Conclusions A telephone referrals and advice database provides clinical governance, serves as a quality indicator and forms a contemporaneous record at the referral centre. Activity data and knowledge of disease burden help to tailor services to the needs of referrers and commissioners. We recommend implementation of similar models in other centres that give extramural verbal advice.


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