HOW TO MAKE FRIENDS (WITH COMMISSIONERS) AND INFLUENCE ADMISSION RATES—OPENING A PAEDIATRIC OBERVATION UNIT IN THE CHILDREN'S EMERGENCY DEPARTMENT


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Abstract

Objectives & BackgroundContinuing building pressure on Emergency departments across the country are well documented in the media. Annual increases in activity (currently 7% locally) are also being seen in the Children's Emergency departments, within a system that has not seen Paediatric inpatient bed numbers increase. There is a commissioning drive to reduce inpatient admission rates, targeting those with a ‘zero length of stay'. Staffing in paediatric emergency departments has an emphasis on a senior decision maker but this continuity if lost when patients are subsequently admitted to an inpatient area.We opened a paediatric observation unit in April 2014 with the aim of managing patients beyond the UK Government set 4 hour target with a maximum length of stay of 8 hours and hypothesised by restricting admission to a number of simple conditions we could safely reduce hospital inpatient admission.MethodsRetrospective observational study reviewing the impact on the children's hospital of patients admitted to a newly built paediatric observation unitResultsIn year 1 we have reduced hospital inpatient admission by 27% with no increase in reattendance rates. Triage times have improved significantly. Breaches remain the same. The main conditions admitted to the observation unit were children with respiratory problems, gastroenteritis, and children awaiting blood results. Average length of stay on the observation unit is 3:07 hrs with a total average stay (ie including time spent for the CED attendance) is 6:52 hrs. High patient satisfaction is also seen, particularly with regards to improved continuity of care: – ‘Having the observation unit I found much better than being sent up to the ward as my daughter was able to see the same doctor throughout her stay. She was also able to be moved from A and E to the observation ward sooner, and I did not have to explain to several people what had brought us into hospital. I also found the discharge process was completed faster.ConclusionOpening a paediatric observation unit within an existing Children's Emergency department significantly reduces inpatient admission to general paediatric wards. It allows for greater turnover of patients than traditional ward round systems, improved continuity of care, supports commissioning agendas and most importantly leads high patient satisfaction.

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