Background Preventable neonatal admissions are an unnecessary expense to hospital trusts, a traumatic experience for families and put neonates at increased risk of hospital acquired infection. Aims To assess the incidence of neonatal readmissions to a London paediatric department and to analyse the diagnosis & management of neonates re-admitted with feeding problems. From this we aim to observe any correlation between length of birth stay and length of readmission stay. Methods A retrospective audit was conducted on all infants (≤ 28 days) that were readmitted between Oct 2011–Oct 2012. A review of the paper notes and discharge summaries was carried out for all those with a primary diagnosis code including ‘feeding’. Results A total of 266 (8% of a total of 3308 paediatric admissions) neonates were re-admitted over 13 month period. 42 had a primary diagnosis of feeding problems. 36 of these notes were available for analysing. 26 (72%) readmitted under 1 week of age. The 3 most common presenting complaints were reduced feeds, weight loss and jaundice. An organic cause was found in only 4 cases. There was a small positive correlation between length of birth stay and length of readmission stay. The most common intervention was a feeding plan given to 33 (92%), followed by feeding advice and counselling (22%) and antibiotics (17%). The admission versus discharge mode of feeding showed a drop in breast feeding from 61% to 3% and an increase in mixed feeding (breast and bottle) from 25% to 72%. Conclusion Better community support around neonatal feeding particularly in the first week of life could reduce the number of preventable neonatal readmissions. Hospital based treatment for feeding problems is likely to result in a change in feeding method away from breastfeeding alone.
Aims Chest pain is a common reason for presentation to the children’s emergency department (ED). It is known that chest pain in children, compared to adults, is much less likely to be caused by cardiovascular disease. Electrocardiographs (ECGs) are cheap, fast and readily available. When interpreted appropriately they can be useful in demonstrating cardiac causes of chest pain. We aimed firstly to determine the incidence and likely causes of paediatric chest pain presenting to our busy Children’s ED and secondly to analyse the usefulness of ECGs in this cohort. Methods We retrospectively analysed the ED case notes of all children (aged under 16 years) presenting with chest pain over a 4 year period (April 2009 to March 2013) to a busy Children’s ED in an urban district general hospital. Results 1126 attendances presented with chest pain, approximately 1% of all attendances over four years. Of those with chest pain 54% were male and the modal age of presentation was 12 years. Based on history and clinical examination the commonest cause attributed to chest pain was musculoskeletal. Only 1% of cases had a possible cardiac aetiology; 1 patient had pericarditis, 1 patient had myocarditis, 2 patients had a pre-existing cardiac condition, 3 patients had arrhythmias and 8 were under investigation for recurrent palpitations. Thirty per cent of patients with chest pain had an ECG carried out. Patients with cardiovascular, psychiatric and musculoskeletal diagnoses were most likely to have had an ECG done. The majority of ECGs were normal (91%). The commonest abnormality was high take off/mild ST elevation, with only 10% of such patients having cardiac enzymes requested. Some of the ECG abnormalities identified could not be attributed to chest pain. Conclusion Incidence of chest pain presenting to our ED was 1%. The commonest recorded cause was musculoskeletal. Fewer than 1% had a possible cardiac aetiology for chest pain. ECG is a useful test for children presenting with chest pain. Very few patients with mild ST elevation had cardiac enzyme levels checked.
Introduction Effective handover is vital for patient safety and good patient care. With shift patterns and junior members of staff with variable experience in Paediatrics, a structured handover tool is essential to make handover process effective and efficient. Aim To assess usefulness of a structured handover tool CHAPS. “C: Clinical picture H: History A: Assessment P: Plan S: Sharing of information” amongst junior members of staff in a busy Paediatric unit in a District general Hospital. Methods It was a prospective study. The handover tool CHAPS was introduced to junior members of staff. 4 weeks after introduction a structured questionnaire was sent to all junior members of staff contributing to handover to assess their opinion about this tool. The study was done over period of 6 weeks from October 2013 to November 2013. Results The questionnaire was sent to total 16 junior members of staff which included registrar, Paediatric trainee, GP trainee, Foundation trainee. 12 of 16 members of staff responded to the questionnaire. All 12 who responded agreed or strongly agreed that the tool makes handover efficient. 83% of respondents felt that CHAPS tool makes handover consistent for patients. 75% of respondents agreed that the tool gives optimum information about patients. All disagreed that CHAPS handovers system is poorly structured. Majority of members of staff (83%) felt that CHAPS handover tool has overall improved quality of handover and patient care. 10 out 12 respondents felt that CHAPS tool has helped them by increasing confidence in handing over patient care in a Paediatric unit. Conclusion “CHAPS” offers an efficient, consistent, sustainable and structured handover tool which works well in Paediatric setting. It helps junior members staff with limited Paediatric experience, structure their handovers resulting in improved quality of handover and patient care.
Introduction The Children’s Ward at University Hospital Lewisham is a 16 bed inpatient unit serving the South London boroughs of Lewisham and Greenwich. The general paediatrics team working in this department is made up of 2 F1 trainees, 6 SHOs and 8 Paediatric Registrars. Minor procedures undertaken by the team take place daily in the treatment room on Children’s Ward, such as peripheral cannula insertion, venepuncture, lumbar puncture, wound care and dressing changes. Aims A quality improvement project was undertaken to enhance the design and organisation of the room in order to improve the efficiency and care given to all inpatients undergoing a minor procedure on the Children’s Ward. Methods An initial questionnaire was distributed amongst the junior paediatrics team to collect opinions on the state of the treatment room as it was then and explore ways of further improving it. After compiling a list of problems and suggestions to resolve these issues, a proposal was brought forward to the Departmental Matron and a small budget was allocated to implementing subsequent changes to the room. The same questionnaire was then re-distributed amongst the team to follow-up on the changes and discovers what difference, if any, these had made. Results All 16 members of the junior paediatrics team disagreed or strongly disagreed that the treatment room was easy to use, stocked adequately or well-organised. The main problems highlighted were that it was untidy, there was limited labelling of drawers, the arrangement of equipment was not in a logical way and it was inadequately stocked. A new trolley of drawers was purchased, the layout of apparatus was rearranged, weekly stocking of equipment was designated to a named healthcare assistant and bright new labels were made. Subsequently, colleague satisfaction much improved. Conclusion Improvement in the efficiency and care given to inpatients undergoing a minor procedure on the ward can be made by rearranging and restructuring a treatment room with very little resources required. By listening to the opinions of the junior paediatrics team who predominantly use the room and acting upon those ideas, small changes can make a large difference to daily routine procedures that are undertaken on a ward.
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