The RCPCH Child Protection Companion provides guidance on medical report writing. We wanted to audit local medical reports against this guidance. Reports are shared with social care and police child abuse investigation team (CAIT), contributing to decision making for children. We therefore wished to determine whether our local social care and CAIT teams felt the opinions in the reports were helpful to their decision making. A retrospective audit of reports of 24 children seen in the first half of 2014 was undertaken, using section 16 of the RCPCH companion as standards. 3 reports from each of the 8 consultants were chosen at random. CAIT and social care reviewed the same 24 reports and completed a proforma regarding key aspects of the medical opinion. Patients’ details, consultation time/place, specific concerns, appearance of the child, past medical, family and developmental history were completed in all reports. 75% gave the child’s own words where applicable, 89% gave information regarding school/nursery and 64% commented on parent/carer interaction. Most reports commented on the need for section 47 investigation but made no direct statement on whether it was safe for the child to return home. Social care and CAIT thought 19 and 16 reports respectively were helpful in decision making. Reported unhelpful factors were non-committal wording on the likelihood of NAI, ambiguity around sibling cases and lack of documentation regarding evidence for neglect concerns. Clear documentation of patients’ and consultation details reflects local strong administrative support. Key areas for child protection, notably the words of the child and child parent interaction were lacking and should be highlighted in training. Paediatricians may have made verbal recommendations during the medical but documentation of this is imperative. The satisfaction of CAIT/social care with reports depends upon their expectations as well as the doctor’s clarity. In some cases the doctor could not have given a ‘clear’ opinion based on what was in front of them. It is valuable for local audits of child protection reports to involve local CAIT and social care to optimise the usefulness of reports in safeguarding of children.
Policies to promote social distancing can minimize COVID-19 transmission, but come with substantial social and economic costs. Quantifying relative preferences of the public for such practices can inform policy prioritization and optimize uptake. We used a discrete choice experiment (DCE) to quantify relative “utilities” (preferences) for five COVID-19 pandemic social distances strategies (e.g., closure of restaurants, restriction of large gatherings) against the hypothetical risk of acquiring COVID-19 and anticipated income loss. The survey was distributed in Missouri in May-June, 2020. We applied inverse probability sampling weights to mixed logit and latent class models to generate mean preferences and identify preference classes. Overall (n=2,428), the strongest preference was for the prohibition of large gatherings, followed by preferences to keep outdoor venues, schools, and social and lifestyle venues open, 75% of the population showing probable support for a strategy that prohibited large gatherings and closed lifestyle and social venues. Latent class analysis, however revealed four preference sub-groups in the population - “risk eliminators”, “risk balancers”, “altruistic” and “risk takers”, with men twice as likely as women to belong to the risk-taking group. In this setting, public health policies which as a first phase prohibit large gatherings, as well as close social and lifestyle venues may be acceptable and adhered to by the public. In addition, policy messages that address preference heterogeneity, for example by targeting public health messages at men, could improve adherence to social distancing measures and prevent further COVID-19 transmission prior to vaccine distribution and in the event of future pandemics.Significance StatementPreferences drive behavior – DCE’s are a novel tool in public health that allow examination of preferences for a product, service or policy, identifying how the public prioritizes personal risks and cost in relation to health behaviors. Using this method to establish preferences for COVID-19 mitigation strategies, our results suggest that, firstly, a tiered approach to non-essential business closures where large gatherings are prohibited and social and lifestyle venues are closed as a first phase, would be well aligned with population preferences and may be supported by the public, while school and outdoor venue closures may require more consideration prior to a second phase of restrictions. And secondly, that important distinct preference phenotypes - that are not captured by sociodemographic (e.g., age, sex, race) characteristics - exist, and therefore that messaging should be target at such subgroups to enhance adherence to prevention efforts.
Infants require a full physical examination within 72 h of birth and again between 6–8 weeks of age. NICE Clinical Guideline CG37 titled ‘Routine postnatal care of women and their babies’ specifies a 43-part list of expected examination points. We wanted to determine the proportion of infants attending for their 8–week baby check at a local General Practice, who had adequate documentation of examination findings in the electronic health records (EHR). The audit also aimed to determine if practice could be improved using an online template. A retrospective audit assessing documentation of examination findings for the 8-week check was performed on 20 patients attending the practice during a four-month period. 100% babies at the 6–8 week check should have all 43 criteria entered into the EHR. Each patient was given a score relating to the number of criteria documented. We then created a unique, easily identifiable ‘8–week baby check’ electronic template for use with the EHR and doctors in the practice were trained in its use. Subsequent re-audit on a sample of 20 patients completed the audit cycle. The initial audit showed overall percentage documentation was 22%, well below the 100% standard. Best recorded were the red–reflex, heart sounds and hips, entered for 11 of 20 patients. 0 of 20 patients records commented on hands, feet, nose, ears, neck or presence of dysmorphism. 8 patients had only ‘8-week check OK’ entered into the EHR. Re–audit once the electronic template was in place showed a 73% improvement in documentation, with all 43 criteria being entered for at least 95% of the children. The initial audit highlighted inadequate documentation of examination findings in the EHR at the 6–8 week newborn check. A well-designed intervention was shown to significantly improve practice thus maintaining medico-legally sound patient notes and optimising patient safety, as the template ensures comprehensive examinations are performed. With increasing shifts towards paperless advanced software systems, there are ample opportunities to improve the quality of care and documentation.
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