This is the biggest, trainee led, prospective national paediatric audit to date Our hospital is taking part

Guidelines RCOA recommends that hospitals regularly audit their unplanned admissions[1] Adult unplanned admission rates should be <2% [2,3] & paediatric rates should approximate to this[4] 1. Guidance on the Provision of Anaesthetic Services (GPAS). Royal College of Anaesthetists. 2016 2. Raising the Standard: a compendium of audit recipes. Section 5: Day Surgery Services, Section 9: Paediatrics. Royal College of Anaesthetists. 3rd edition, 2012 3. Paediatric day-case surgery: an audit of unplanned hospital admission Royal Hospital for Sick Children, Glasgow. Blacoe DA, Cunning E, Bell G. Anaesthesia. June 2008 63(6):610-652 4. Awad IT et al. Unplanned hospital admission in children undergoing day-case surgery. European Journal of Anaesthesiology. May 2004:21(5):379-383

The Problem Rate of unplanned paediatric day case admissions unknown in UK More information is needed to identify what factors contribute Eg ASA, pre-assessment, surgical procedure, surgical duration, We may identify interventions that could reduce unplanned admissions

Phase I Retrospective audit (1st Jan 2016 – 31st Dec 2016) Data from 48 hospitals This provided an estimate of: No. of paediatric day case anaesthetics in the UK No. of admissions Retrospective phase has been performed (Phase 1) The aim of this was to gauge the approximate number of day case general anaesthetics performed and the number of unplanned admissions in the study hospitals over a 12 month period. A total of 63 hospitals engaged in Phase 1. 48 hospitals were able to provide a full data set. 16 hospitals were unable to access the data from their computer systems. A further 20hospitals have shown interest in engaging with the prospective phase (Phase 2). Based on the figures collected from Phase 1, the total annual day case procedures for the 48 hospitals contributing data was 101,381cases, with 4515 admissions. We estimate that the monthly caseload would be approximately 8448, with 376 unplanned admissions for these 48 hospitals. We are aware that there may be some data inaccuracy owing to the retrospective study design. We aim to increase the size of these figures by running Phase 2 for 6 weeks and to recruit more than 48 hospitals.

Phase II Is registering now! We are taking part Phase II is national and prospective Data collection 10th October – 21st November 2017

Phase II aims Prospectively identify proportion of unplanned admissions Across the UK In specialist & non-specialist centres Identify common contributing factors involved in unplanned admissions Generate data for future quality improvement projects

Phase II Data Collection All patients 0-16 listed for a day case GA procedure Elective or Urgent/Emergency Includes Endoscopy & Radiology Unplanned admission is considered as : ANY paediatric patient, who on arrival to hospital did not have an overnight bed booked who subsequently stays overnight This will help pick up those cases inappropriately booked or “forgotten” about No patient identifiable data will be collected.

Phase II Data For each unplanned admission the following data will be collected: Patient demographics ASA grade, procedure, specialty, timings Reason for admission

Running Phase II in Your Hospital Team - Consultant supervisor, PATRN representatves Register your centre with PATRN Registration is now open Registration (intent of participation) deadline 8th September Register the project with your local audit department now Data collection 6 weeks 10th October –21st November See ‘Getting Started’ document

Running Phase II in Your Hospital Ethics are not required for this audit project Patient consent is not required for this audit project PATRN CANNOT ACCEPT YOUR DATA WITHOUT LOCAL AUDIT APPROVAL Deadline 6th October 2017 but please return before this so we can get your login to the secure data portal to you. 

Data Collection Advertise & promote the study Work out your hospital logistics and a robust strategy How will you identify unplanned admissions? Day ward, bed managers, recovery staff Please see our data collection guide for suggestions

At the end of Data Collection All data needs to be uploaded by 20th December 2017 Extract total number of planned day case procedures from your theatre IT system (with help!) at the end of the 6 week data collection period Please remove hospital numbers from your data and make sure you send age, not DOB Certificates of contribution by Feb 2018 & aim to publish analysis of results Autumn 2018

Thanks!

Further information: https://twitter. com/patrn_apagbi https://www References 1. Guidance on the Provision of Anaesthetic Services (GPAS). Royal College of Anaesthetists. 2016 2. Raising the Standard: a compendium of audit recipes. Section 5: Day Surgery Services, Section 9: Paediatrics. Royal College of Anaesthetists. 3rd edition, 2012 3. Paediatric day-case surgery: an audit of unplanned hospital admission Royal Hospital for Sick Children, Glasgow. Blacoe DA, Cunning E, Bell G. Anaesthesia. June 2008 63(6):610-652 4. Awad IT et al. Unplanned hospital admission in children undergoing day-case surgery. European Journal of Anaesthesiology. May 2004:21(5):379-383