Transcript Acute Paediatrics Transforming Your Care (TYC)

Angela Pollock and Paula Forrest
Assistant Service Managers
Royal Belfast Hospital for Sick Children
15 February 2013
Where are we now?
 Civil Eyes Workshops
 Benchmarking workshops for Acute paediatrics
 Benchmark with 15 other paediatric centres in the UK
 How 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 achieved
 Introduction of Day of Surgery Unit
 Introduction of Pre assessment
 Centralisation of service referrals which are then triage
to the appropriate care setting
 Orthopaedics / Asthma / Epilepsy
 Scoping of OP clinics to move to Health and Well
being centres
 Diabetes / General Medical
Next Steps 1: The Manchester
Model
 CCN managed within Acute Sector – based in the same
building
 Attend the daily COW ward round 7 days a week
 Aid discharge process
 Identify possible pathways for children to the
community
 Rotational Posts – set number every year
 3 places over a year – 4 month placements each
 A&E / SSPAU, Inpatient ward and Community
Working pattern
 8am to 10pm Monday to Friday
 8am to 8pm Saturday and Sunday
 On-call system
 to deliver care for End of Life
 To support Care Workers managing complex children in
the community
Possible referrals:
 IV Antibiotics
 Dressings
 Support with enteral feeding
 Facilitation of equipment provision
 Ongoing family support/teaching
 Diabetes team
 Better Links with specialist services i.e. CYSTIC
FIBROSIS/ONCOLOGY
Next Steps 2: CRAFT team
 CCN 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 referrals
 High temperatures-fever management
 Vomiting and diarrhoea-hydration checks
 Viral wheeze, bronchiolotis, asthma, croup
 Coughs, colds & pneumonia
 Ear & throat infections
 Constipation
 Rashes
 Gastro-oesophageal reflux
 Henoch-Schonlein Purpura
 UTI
Interventions
 Observation/monitoring
 Administration of medication
 Collection of laboratory samples
 Family support
 Teaching of other professionals
Educational Needs
 Rotation posts for both local Trust and regionally
 Simulation Training – updates for whole region
 Regional standards for paediatrics
 Standardisation of services across NI for paediatrics;
equity of service
 Workforce standardisation of roles, Band 6’s in Special
Needs Schools, Band 3 at home with ventilated
Children
 Modernisation of skill mix