53 Piloting patch – providing assessment and treatment for children at home – and piecing together what works

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Abstract

Aims

PATCH is a pilot acute community children’s nurse led service delivering assessment and treatment for children at home who are moderately unwell and might otherwise be admitted to hospital or attend Paediatric Emergency Department (PED). Children are referred by PED or GP and followed up via telephone support and home visits depending on clinical need for duration of acute illness.

Methods

Pilot year funded by Imperial Charity. Using evaluation to build business case for sustained commissioned service.

Methods

Phase 1 Sept 2016 – May 2017: reduced short stay admissions and re-attendances to PED for common mild-moderate respiratory conditions e.g., viral wheeze, bronchiolitis.

Methods

Phase 2 from May 2017: piloting direct GP referrals to PATCH team to evaluate impact in reducing attendances to PED for children needing further assessment or support beyond GP consultation, and enabling families to manage common acute conditions at home.

Methods

Using QI methodology, Model for Improvement we developed a driver diagram and used real-time PDSA cycles to capture our learning and inform small iterative changes of service development. Process mapping and world cafe style events were held with local community nurses, health visitor leads, GPs and commissioners to co-design referral pathways and explore more widely how PATCH fits into the whole urgent care system.

Methods

Parental feedback evaluated via semi structured interviews.

Results

Activity – Appendix 1

Results

Phase 1 – Concentrated on respiratory conditions from PED.

Results

Total 188 referrals in first 7 months. Bronchiolitis 45%; viral wheeze 37.5%; asthma 7%; lower respiratory tract infections 5.4%.

Results

50% of patients received home visits and telephone consultations; 50% only telephone support.

Results

Successes: Cost effective – Appendix 2

Results

73 acute admissions avoided, costing c£400 per/night

Results

97 PED re-attendances prevented at £117 per attendance.

Results

Projected cost avoidance within acute care provider £3 27 640 pa.

Results

Estimated cost of service £2 84 000 pa.

Results

Positive feedback and reported health seeking behaviour change – Appendix 3

Challenges

Information governance, cross organisational working, complex commissioning arrangements.

Discussion

Within first 7 months PATCH has had a significant impact on avoiding admissions and re-attendances, thus improving flow and performance in PED. The projected financial impact is that it is cost effective.

Discussion

We are using this data to pursue a business case internally and with local CCGs. We are optimistic of succeeding and using phase 2 to build on partnerships garnered across the whole system to expand PATCH’s impact further by reducing PED attendances and continuing to improve our local urgent care pathway for children.

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