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

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

3. 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

4. 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

5. 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”

6. 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

7. 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

8. 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

9. 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

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

11. 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

12. 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