What was the aim of the project?
Healthcare delivered in emergency departments is very expensive, relative to primary care. Swindon Clinical Commissioning Group (CCG) wanted to find out if any children who were being seen by the paediatric emergency team in hospital (without being admitted) had potential to be managed within primary care.
Simultaneously, the paediatric hospital team communicated that they were keen to establish an advice telephone service for GPs. Improved GP access to a paediatric doctor is one of the benefits identified in a report about consultant-led services by the Academy of Royal Medical Colleges. This is referenced by the Royal College of Paediatrics and Child Health in their 2015 paper; ‘Facing the Future’.
Who was involved?
Great Western Hospital and Swindon Clinical Commissioning Group.
What was the aim of the evaluation?
To review the appropriateness of emergency paediatric admissions, and to assess how access to a paediatric advice line may have supported cases being more suitably managed in primary care.
What resources and people were involved?
Dr Francis Campbell, GP Clinical Evidence Fellow with Swindon CCG (funded by the West of England Academic Health Science Network and Swindon Clinical Commissioning Group).
What did they do?
Francis obtained and reviewed a random sample of hospital notes for 0 day length of stay for 0-16 year olds over the four month winter period (November 2014 to February 2015) when A&E attendance for paediatric respiratory illness peaks. He reviewed the notes to assess, in his clinical judgement as a GP, which cases may have been managed appropriately in primary care, particularly if telephone access to a paediatric specialist was available.
What did they find?
Of 35 reviewed cases, Francis assessed that a significant number of cases were likely to have been managed successfully in primary care if access to a paediatric specialist was available through an advice line. On this basis, A&E attendance could potentially be reduced.
There were also three cases identified that clearly did not need hospital-level review or intervention and would have been more efficiently seen in the community urgent care centre (SUCCESS) children’s clinics.
Who was the evidence shared with and why?
Findings were presented to the CCG Clinical Leadership Group.
These findings increased Swindon GGG’s confidence in trialling a paediatric advice line for GPs to contact specialist paediatricians.
What has changed as a result?
The advice line is still operational. Its evaluation is pending, following a change in programme lead.
Successes and challenges
An improved working relationship between Great Western Hospital and Swindon Clinical Commissioning Group.
The evidence collected from review of patient notes caused tension for some cases that could have been managed differently. Maintaining good relationships between the hospital staff and commissioners was essential.
The number of cases reviewed in the audit was a relatively small sample size.