G306(P) Can an urgent care centre and paediatric assessment unit replace a paediatric emergency department and inpatient ward?

Abstract

Following closure of both the paediatric inpatient ward and emergency department of a district hospital in December 2013, a free standing Urgent Care Centre (UCC) and Paediatric Assessment Unit (PAU) were established, open for 14 hours per day. This study presents 36 months of data to identify the volume and nature of the presentations to UCC and PAU including the sources of those attendances, the outcomes of the visit and the frequency with which children required transfer to neighbouring acute hospitals. The trends in referrals from local GPs, from inpatient wards for the ongoing care of ambulating patients, from Homecare Nurses, Midwives and Health Visitors, and the volume of self referred walk-in patients, are analysed, with focus on key local events, including changes in the advertising campaign marking the launch of The Unit, publicity following the death of a child brought to the site when the Unit was closed, the merging of neighbouring Trusts, and the local CCG announcing a public consultation regarding the future of The Unit. The analysis identifies key features of the Unit’s activity, including: that attendances initially dropped to less than 50% of the pre December 2013 levels, before recovering to nearly 70%. that transfers fell from 13% of total presentations in the first year of the Unit, to 8% by year 3, as families became more aware of the services that could be offered. that referrals from UCC staff to the PAU fell, as UCC clinicians became more confident in managing paediatric cases, with the support of paediatric band 7 Nursing Sisters, whose role was extended within a ‘see and treat’ model. that referrals from GPs fell from 24% of total presentations in the first year, to less than 10% in the third year, as uncertainty surrounding the Unit’s future grew following announcement of the CCG consultation The paper identifies those factors that have contributed to the safe running of the Unit, including the triage role of senior paediatric nurses, the efforts made to communicate with stakeholders, including local families and primary care teams, and also the areas where data collection was less than complete, such as the recording of advice telephone calls, all of which have impacted on the current CCG consultation.