Paediatric Ambulatory Care - A Model of Care - Dr. Jackie Bucknall Homerton Hospital London

Objectives Today Background Demography Our Service aims Stand Alone Ambulatory Unit Activity Lessons we Learnt

Reprovision of East London Children’s Services 1998 East London & City HA 5 Acute Hospitals inc. 4 A&E Depts, Children’s Hospital & No acute paeds. Mix of Management models in district QEH acute children’s service provider Secondary general care to Homerton Tertiary/specialist/inpatient care to RLH

Hackney - Demography Population of under 16 years >54,000 Area high deprivation & need Multicultural & ethnic mix - 47% High refugee & migrant community Significant percent not registered PHCT

Aims of Homerton Acute Paediatric Service High quality care led by senior clinicians Care accessible to all local population Avoid unnecessary admission to hospital & facilitate early discharge Family Centred individualised care Offer partnership in care, empower families & primary care Develop integrated Children’s service with RLH on “hub/spoke model”

Key Service Elements Children’s Emergency Assessment (A&E) Stand Alone Ambulatory Care Unit Hospital at Home Service Primary Care Hotline GP Rapid Referral Service Outpatients Transfer Service

A Stand Alone Ambulatory Care Unit - What is it? Acute Assessment & Observation Unit 24 hour admission remit Establish AND Maintain Philosophy Review & Reassessment critical No long term care /inpatient unit on site Supports A&E / Emergency care Acute medical /Elective surgical service

A Stand Alone Ambulatory Care Unit - How does it work ? Tailored to local need & demand Robust inpatient provider locally Senior assessment / Multidisciplinary Proactive decision making Observation facility To support A&E - need 24 hour assessment & on site paediatric team Good gatekeeping

Why 24 Hours ? Emergency Care Support Different models of Ambulatory care in same population during reconfiguration With 24 hour Ambulatory support A&E transfers fell (8.4% to 3.5%) Despite change casemix & increased activity Statistically significant changes(p<0.001) Supporting 24 HOUR Model

Service Activity (00/01) A&E attendances - 18,700 Outpatients - 7,900 + 1,500 GPRR Inpatient Equivalent - 3,400 (18%) Hospital at Home - 450 children Total Transfers - 5.1% (954 children) 94.9% CHILDREN ARE TOTALLY CARE MANAGED IN AMBULATORY SERVICE

Transfers 3.5 % Total A&E attendances 9% of ACU admissions 80% Received Nominated IP receiving Unit - Royal London Children’s Service 59% Emerg. Surgical 11% PICU 27% Medical

Lessons we Learnt Locally Appropriate Robust Inpatient Centre 24 hour Paediatric support to A&E Consider Casemix AND Activity Good Gatekeeping Training/Retention Nurse Practitioners Creative/Flexible Medical Staffing