1. “My First Family Outing” When Newborns come to the ED
Lizzie Wortley
PICH
3.4.19

2. OUTLINE Finding out what’s happening Doing something about it
Getting hold of data – how why when where
Analysing data – making it meaningful
OUTLINE
Doing something about it
Who do I tell & how do I keep them interested?
What about the patients?
What can we do? Is it my job to do it?
What I’ve learned along the way
Where next?

3. Background My Medical Life What matters to me ST6 London paeds trainee
Experience of what a paediatrician can do
Background
What matters to me
My family
Having a purpose

4. The baby is fine, so should only take 10 minutes Vs The family are struggling, and need to be heard and supported

6. How could I answer that question?

8. HRA decision tool

9. What do I actually need to know?
16MB Download

10. What does the data show? Born in hospital 2017 5070 Attend ED 2017
1085
21%
Hospital birth records & attend ED
705
14%

11. My ”Journey”
What makes a mother with a tiny baby decide to venture to ED?

12. The hunch is correct – who needs to know?

13. Stakeholder meeting

14. Don’t let your passion kill other people’s interest

15. What did other people say?
“it’s lack of family support”
“We know”
“Nothing works”
“parents expectations are too high”
“It was really good once, but they cut funding”
Cathartic outpourings
”you’re putting pressure on new mums”
“it’s …. Ethnic group”

16. What engages people?

18. How do you make sure you hear the voice of the patient

19. Cautions?

20. Patient map Pre-pregnancy mother fomrula fed M, BF younger sibling
no 'real' BF experience
Had seen BF in public - just a head againast a chest, "but you don't look"
close friends had kids in USA whilst M living here (tell you things, but not seeing them)
Pregnancy
MW antenatal care
due to complications of pregnancy so busy talking about current symptoms,m not much talk about after birth
NCT group
one eve class with NCT on BF
takeaway from class was LATCH
Labour
48 hours
friday night to sunday eve
epidural and iv fluids
Postnatal HOSPITAL
couple of feeds possibly seen by MW
So busy, know they don't have the time
no BF support worker etc
Home (monday)
Think all going ok
Home (tuesday)
Breast start to get sore.
Mother comes from USA - says it hurts, so continues as is "toe curling and you just have to get through it"
MW visits - bu more concerned about other effects of delivery than feeding and so not much discussed
Home wendesday
feeding now really painful
overnight in tears
calls helpline - advised to go to local BF group next day
BF group thursday
baby weighed % wt loss
advised A&E
advised dad to buy formula milk
A&E (thursday)
Admitted
iv cannula and bloods
iv abx
3 day admission
EBm and fomrula fed

21. Methods

22. Pateints need to drive the change!

23. What did stakeholders say later?
“I’m sorry I wasn't engaged more at the beginning, what can I do now to help?”
“Can I invite someone else along?”
“WE”
“Let’s do…”
“Can we…”

24. Where next? Evidence base A&E deep dive info
Comparisons with baseline data
Doctor survey
Stakeholder mapping
The ideas
Where next?
Note down slide where set restarts for easy maneouvering

25. Evidence base Literature reviews Why do people come to A&E?
Why bring your neonate to A&E?
Do other places have this problem
What is supportive newborn care?
What influences breast feeding success (in itself and as proxy for parenting support?)
Evidence base

26. Comparisons to baseline data
What’s already known?
Comparisons to baseline data

27. Does this add up with what’s already known?
Risk factors for not breast feeding successfully:
First baby
- c section
- premature
Maternal age

29. Doctors survey

30. Stakeholder mapping

31. The ideas Day 3 visit Telephone support for one week – proactive
Antenatal match ups with breast feeding groups
Peer support workers on PNW
Best beginnings baby buddy app
Increase staff training
Antenata classes more parenting classes
Post natal classes
The ideas

32. What’s been tried before

33. Difficulties along the way
Both ‘owning the project’ & being junior – knife edge balancing act
Engagement of management
Co-ordnination of so many teams
Maintaining interest
Infant feeding co-ordinator other interests
Job span

34. Where next?
Harrow Public Health are determined to continue with this work - hospital link
Had meeting with CCG head of children’s and presented data – shocked and want to do something
Managed to go to a Maternity Voices Partnership meeting – will happily survey on facebook (still need to get confirmation that’s ok)
Sustainability – who can continue at hospital site

35. Contacts and references
@lizziewortley
Contacts and references