Children, frailty and vulnerable patients

Some patients need a lower threshold for escalation when deterioration is reported. Babies, children, frail adults, care-home residents, people with learning disabilities and people who cannot clearly describe symptoms may become unsafe before the problem is fully understood.

Vulnerability does not mean reception staff should make clinical decisions. It means uncertainty should be escalated sooner, especially when the caller describes a change in behaviour, alertness, drinking, urine, breathing or ability to manage.

Use extra caution when the contact involves

• Babies or children who are sleepier than usual, not drinking, breathing differently, not passing urine or described as "not themselves".
• Frail older adults with sudden weakness, falls, confusion, reduced drinking or reduced urine.
• Care-home residents where staff report a clear change from baseline.
• People with learning disabilities or communication difficulties where behaviour change may be the main sign of illness.
• Recently discharged patients who say they are worsening, unable to manage or unclear about follow-up.
• Patients living alone where failed contact, confusion or reduced mobility may increase risk.

Listen to people who know the patient

A relative, carer or care worker may know the patient's normal behaviour and ability. "This is not normal for them" can be important safety information, even when the symptom list is incomplete.

When the patient is vulnerable and the information is uncertain, escalate rather than attempting to make a clinical judgement at reception.

Vulnerability note

When a vulnerable patient is described as worse, not themselves or unable to manage, uncertainty should lower the threshold for escalation.