Appendix 5 Acute Paediatrics Transforming Your Care (TYC)

Angela Pollock and Paula ForrestAssistant Service Managers

Royal Belfast Hospital for Sick Children

15 February 2013

Where are we now?Civil Eyes WorkshopsBenchmarking workshops for Acute paediatrics Benchmark with 15 other paediatric centres in

the UKHow do we compare / what do we need to

change?Scope Models of Care already in place

Surgical specialties: % day cases

Surgical specialties: % same day operations for elective activity

Surgical specialties: inpatient length of stay

30 Day emergency readmissions vs. length of stay – non-elective activity (excluding GOSH)

% Emergency readmissions within 7 days

% Emergency readmissions within 30 days

What has been achievedIntroduction of Day of Surgery UnitIntroduction of Pre assessmentCentralisation of service referrals which are

then triage to the appropriate care settingOrthopaedics / Asthma / Epilepsy

Scoping of OP clinics to move to Health and Well being centresDiabetes / General Medical

Next Steps 1: The Manchester ModelCCN managed within Acute Sector – based in

the same buildingAttend the daily COW ward round 7 days a

weekAid discharge processIdentify possible pathways for children to the

communityRotational Posts – set number every year

3 places over a year – 4 month placements eachA&E / SSPAU, Inpatient ward and Community

Working pattern8am to 10pm Monday to Friday

8am to 8pm Saturday and Sunday

On-call system to deliver care for End of LifeTo support Care Workers managing complex children in

the community

Possible referrals:IV AntibioticsDressingsSupport with enteral feedingFacilitation of equipment provisionOngoing family support/teachingDiabetes team Better Links with specialist services i.e.

CYSTIC FIBROSIS/ONCOLOGY

Next Steps 2: CRAFT teamCCN accepts referrals from any provider of

emergency/unscheduled care in an attempt to reduce the need for SSPAU/acute admission

Referrals also accepted for follow-up visits from ED/SSPAU/inpatient wards to facilitate safe earlier discharge

CCN visits within 4 hours of receiving referral

Working pattern

10am to 8pm 7days per week including bank holidays

Answer phone for non-urgent messages 24/7

Parents provided with appropriate contact numbers for out of hours support

Possible referralsHigh temperatures-fever managementVomiting and diarrhoea-hydration checksViral wheeze, bronchiolotis, asthma, croupCoughs, colds & pneumoniaEar & throat infectionsConstipationRashesGastro-oesophageal refluxHenoch-Schonlein PurpuraUTI

Interventions

Observation/monitoringAdministration of medicationCollection of laboratory samplesFamily supportTeaching of other professionals

Educational NeedsRotation posts for both local Trust and

regionallySimulation Training – updates for whole regionRegional standards for paediatricsStandardisation of services across NI for

paediatrics; equity of serviceWorkforce standardisation of roles, Band 6’s in

Special Needs Schools, Band 3 at home with ventilated Children

Modernisation of skill mix