Angela Pollock and Paula Forrest Assistant Service Managers Royal Belfast Hospital for Sick Children 15 February 2013

Where are we now? Civil Eyes Workshops Benchmarking workshops for Acute paediatrics Benchmark with 15 other paediatric centres in the UK How do we compare / what do we need to change? Scope Models of Care already in place

Surgical specialties: % day cases

Surgical specialties: % same day operations for elective activity

Surgical specialties: inpatient length of stay

30 Day emergency readmissions vs. length of stay – non-elective activity (excluding GOSH)

% Emergency readmissions within 7 days

% Emergency readmissions within 30 days

What has been achieved Introduction of Day of Surgery Unit Introduction of Pre assessment Centralisation of service referrals which are then triage to the appropriate care setting Orthopaedics / Asthma / Epilepsy Scoping of OP clinics to move to Health and Well being centres Diabetes / General Medical

Next Steps 1: The Manchester Model CCN managed within Acute Sector – based in the same building Attend the daily COW ward round 7 days a week Aid discharge process Identify possible pathways for children to the community Rotational Posts – set number every year 3 places over a year – 4 month placements each A&E / SSPAU, Inpatient ward and Community

Working pattern 8am to 10pm Monday to Friday 8am to 8pm Saturday and Sunday On-call system to deliver care for End of Life To support Care Workers managing complex children in the community

Possible referrals: IV Antibiotics Dressings Support with enteral feeding Facilitation of equipment provision Ongoing family support/teaching Diabetes team Better Links with specialist services i.e. CYSTIC FIBROSIS/ONCOLOGY

Next Steps 2: CRAFT team CCN accepts referrals from any provider of emergency/unscheduled care in an attempt to reduce the need for SSPAU/acute admission Referrals also accepted for follow-up visits from ED/SSPAU/inpatient wards to facilitate safe earlier discharge CCN visits within 4 hours of receiving referral

Working pattern 10am to 8pm 7days per week including bank holidays Answer phone for non-urgent messages 24/7 Parents provided with appropriate contact numbers for out of hours support

Possible referrals High temperatures-fever management Vomiting and diarrhoea-hydration checks Viral wheeze, bronchiolotis, asthma, croup Coughs, colds & pneumonia Ear & throat infections Constipation Rashes Gastro-oesophageal reflux Henoch-Schonlein Purpura UTI

Interventions Observation/monitoring Administration of medication Collection of laboratory samples Family support Teaching of other professionals

Educational Needs Rotation posts for both local Trust and regionally Simulation Training – updates for whole region Regional standards for paediatrics Standardisation of services across NI for paediatrics; equity of service Workforce standardisation of roles, Band 6’s in Special Needs Schools, Band 3 at home with ventilated Children Modernisation of skill mix