Objective The primary objective of this study was to determine the level of inter-rater reliability between nursing staff for the Paediatric Observation Priority Score (POPS). Design Retrospective observational studySetting Single centre paediatric emergency department Participants 12 participants from a convenience sample of 21 nursing staff.Interventions Participants were shown video footage of three pre-recorded paediatric assessments and asked to record their own POPS for each child. The participants were blinded to the original, in person POPS. Further data were gathered in the form of a questionnaire to determine the level of training and experience the candidate had using the POPS score prior to undertaking this study. Main outcome measuresInter-rater reliability amongst participants scoring of the POPS. ResultsOverall Kappa value for case 1 was 0.74 (95% confidence interval 0.605 to 0.865), case 2 was 1 (perfect agreement) and case 3 was 0.66 (95% confidence interval 0.58 to 0.744). ConclusionThis study suggests there is good inter-rater reliability between different nurses use of POPS in assessing sick children in the Emergency Department.3
AimsThe Paediatric Observation Priority Score (POPS) is a validated paediatric acuity assessment tool for use in emergency and acute care settings. We wished to assess the reliability of POPS by analysing inter-observer variation among nursing staff.MethodsTwelve participants were recruited from a single emergency department nursing team. They were shown video footage of a paediatric advanced nurse practitioner (PANP) assessing three children with different POPS scores. They were blinded to the POPS generated by the PANP and asked to formulate their own POPS score based on the recorded assessment.ResultsFleiss Kappa was utilised for statistical analysis of the individual observational parameters and an overall Kappa value for each case. Kappa values of 0.735 (good) and 0.660 (good) were seen in patients presenting with abnormal physiological observations, and complete agreement (Kappa value of 1) was demonstrated in a child with normal physiological parameters.ConclusionThis study provides evidence that inter-observer agreement in the use of POPS by different nurses in the assessment of sick children is ‘good’. Variation between users of scoring systems has previously been underinvestigated and this study will allow us to further refine POPS to improve its clinical utility.
Aims To introduce a community based nurse-led service with the aim of reducing unscheduled paediatric admissions into hospital, which can safely be managed in the community. Locally, 56% of unscheduled acute admissions into hospital are made by General practitioners (GP). Of these 46% are discharged home within 6 h. Methods The service was run as a 12 month pilot project. Staffed by children's nurses with advanced minor illness management skills, the service provided follow-up visits in the home for children with mild to moderate episodes of minor illness. The target group were children who would otherwise have been admitted to hospital by the GP, Emergency Department or Walk-in-centre. A robust referral system ensured the children were safely discharged home for follow-up. A cluster of GP's, paediatric ED specialists and a consultant paediatrician had input in development of the service. Results The pilot project received 586 referrals. 195 referrals (33%) identified as admission avoidance. Others were referred by clinicians identifying a need for nursing support after discharge. 22 referrals (4%) were returned to hospital for medical review or admission due to change or deterioration in condition. There were no deaths or serious incidents. User satisfaction was high as reported through a service review and evaluation process. Cost analysis Cost to run the service, £160 564. Average cost per referral into the service, £274. ED admission costs £60, hospital admission, £260 on first contact, rising to £700 for a stay >4 h. Total saving £113 340, assuming that the majority of admissions into hospital incur the higher fee. The lesser cost of ED admission is accounted for. Conclusions The cost of delivering the service was greater than the savings realised. However, some savings may not have been counted as it is not possible to identify where parents would have sought medical advice had this service not been available. Some over and under estimation of savings may have arisen for differing lengths of hospital stay. Attracting referrals based on admission avoidance would increase service productivity. Families valued the service highly; felt supported, reassured and recognised the significance of avoiding hospital admission.
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