53 Piloting patch – providing assessment and treatment for children at home – and piecing together what works

Abstract

AimsPATCH is a pilot acute community children’s nurse led service delivering assessment and treatment for children at home who are moderately unwell and might otherwise be admitted to hospital or attend Paediatric Emergency Department (PED). Children are referred by PED or GP and followed up via telephone support and home visits depending on clinical need for duration of acute illness.MethodsPilot year funded by Imperial Charity. Using evaluation to build business case for sustained commissioned service. Phase 1 Sept 2016 – May 2017 : reduced short stay admissions and re-attendances to PED for common mild-moderate respiratory conditions e.g., viral wheeze, bronchiolitis. Phase 2 from May 2017 : piloting direct GP referrals to PATCH team to evaluate impact in reducing attendances to PED for children needing further assessment or support beyond GP consultation, and enabling families to manage common acute conditions at home.Using QI methodology, Model for Improvement we developed a driver diagram and used real-time PDSA cycles to capture our learning and inform small iterative changes of service development. Process mapping and world cafe style events were held with local community nurses, health visitor leads, GPs and commissioners to co-design referral pathways and explore more widely how PATCH fits into the whole urgent care system.Figure 1Parental feedback evaluated via semi structured interviews.ResultsActivity – Appendix 1Phase 1 – Concentrated on respiratory conditions from PED.Total 188 referrals in first 7 months. Bronchiolitis 45%; viral wheeze 37.5%; asthma 7%; lower respiratory tract infections 5.4%.Figure 250% of patients received home visits and telephone consultations; 50% only telephone support.Successes: Cost effective – Appendix 273 acute admissions avoided, costing c£400 per/night97 PED re-attendances prevented at £117 per attendance.Projected cost avoidance within acute care provider £3 27 640 pa.Estimated cost of service £2 84 000 pa.Positive feedback and reported health seeking behaviour change – Appendix 3ChallengesInformation governance, cross organisational working, complex commissioning arrangements.Figure 3DiscussionWithin first 7 months PATCH has had a significant impact on avoiding admissions and re-attendances, thus improving flow and performance in PED. The projected financial impact is that it is cost effective.We are using this data to pursue a business case internally and with local CCGs. We are optimistic of succeeding and using phase 2 to build on partnerships garnered across the whole system to expand PATCH’s impact further by reducing PED attendances and continuing to improve our local urgent care pathway for children.

Home Care for Bronchiolitis: A Systematic Review

“…Two further studies reported on bronchiolitis managed in the home compared with hospital: a publication that included bronchiolitis as 1 of the conditions managed through their HAH program and an abstract reporting a nurse-led telephone review/ home-visit service to avoid representations and admissions for respiratory conditions including bronchiolitis. 33,34 However, neither fulfilled inclusion criteria in that they lacked information describing their patients, their interventions, or their bronchiolitis-specific outcomes.…”

635 Providing Assessment and Treatment for Children at Home (PATCH); better for patients and better for the planet

“…As the PATCH model expands across the 3 other large local trusts this could save the equivalent carbon of driving a small petrol car from London to Liverpool 126 times. 3 Abstract 635 Table 1 Conclusion This model of care demonstrated has already proved to be cost effective and received excellent patient feedback 4 but this demonstrates that there are also significant potential carbon savings. We must encourage quality improvement and service innovation strategies to embrace the triple bottom line model to ensure social and environmental sustainability is embedded into the NHS model.…”