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Paediatric Ambulatory Care - A Model of Care -

Paediatric Ambulatory Care - A Model of Care -. Dr. Jackie Bucknall Homerton Hospital London. Objectives Today. Background Demography Our Service aims Stand Alone Ambulatory Unit Activity Lessons we Learnt. Reprovision of East London Children’s Services 1998 . East London & City HA

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Paediatric Ambulatory Care - A Model of Care -

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  1. Paediatric Ambulatory Care- A Model of Care - Dr. Jackie Bucknall Homerton Hospital London

  2. Objectives Today • Background • Demography • Our Service aims • Stand Alone Ambulatory Unit • Activity • Lessons we Learnt

  3. Reprovision of East London Children’s Services 1998 • East London & City HA • 5 Acute Hospitals inc. 4 A&E Depts, Children’s Hospital & No acute paeds. • Mix of Management models in district • QEH acute children’s service provider • Secondary general care to Homerton • Tertiary/specialist/inpatient care to RLH

  4. Hackney - Demography • Population of under 16 years >54,000 • Area high deprivation & need • Multicultural & ethnic mix - 47% • High refugee & migrant community • Significant percent not registered PHCT

  5. Aims of Homerton Acute Paediatric Service • High quality care led by senior clinicians • Care accessible to all local population • Avoid unnecessary admission to hospital & facilitate early discharge • Family Centred individualised care • Offer partnership in care, empower families & primary care • Develop integrated Children’s service with RLH on “hub/spoke model”

  6. Key Service Elements • Children’s Emergency Assessment (A&E) • Stand Alone Ambulatory Care Unit • Hospital at Home Service • Primary Care Hotline • GP Rapid Referral Service • Outpatients • Transfer Service

  7. A Stand Alone Ambulatory Care Unit - What is it? • Acute Assessment & Observation Unit • 24 hour admission remit • Establish AND Maintain Philosophy • Review & Reassessment critical • No long term care /inpatient unit on site • Supports A&E / Emergency care • Acute medical /Elective surgical service

  8. A Stand Alone Ambulatory Care Unit - How does it work ? • Tailored to local need & demand • Robust inpatient provider locally • Senior assessment / Multidisciplinary • Proactive decision making • Observation facility • To support A&E - need 24 hour assessment & on site paediatric team • Good gatekeeping

  9. Why 24 Hours ? • Emergency Care Support • Different models of Ambulatory care in same population during reconfiguration • With 24 hour Ambulatory support A&E transfers fell (8.4% to 3.5%) Despite change casemix & increased activity • Statistically significant changes(p<0.001) Supporting 24 HOUR Model

  10. Service Activity (00/01) • A&E attendances - 18,700 • Outpatients - 7,900 + 1,500 GPRR • Inpatient Equivalent - 3,400 (18%) • Hospital at Home - 450 children • Total Transfers - 5.1% (954 children) 94.9% CHILDREN ARE TOTALLY CARE MANAGED IN AMBULATORY SERVICE

  11. Transfers • 3.5 % Total A&E attendances • 9% of ACU admissions • 80% Received Nominated IP receiving Unit - Royal London Children’s Service • 59% Emerg. Surgical • 11% PICU • 27% Medical

  12. Lessons we Learnt • Locally Appropriate • Robust Inpatient Centre • 24 hour Paediatric support to A&E • Consider Casemix AND Activity • Good Gatekeeping • Training/Retention Nurse Practitioners • Creative/Flexible Medical Staffing

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