G315(P) An intervention to reduce unplanned hospital admissions in children and young people (CYP)

Abstract

Urgent Care services in the NHS are under huge pressure to deliver better outcomes despite increasing demand, limited resources and tightening budgets. Ninety percent of urgent care for CYP currently managed in hospital can be delivered in the community. It costs the NHS ten times less to look after a CYP at home compared to a hospital admission. Methods The intervention –Ambulatory Care Experience (ACE) Pilot CYP are referred to ACE from Primary Care, A and E and the Children’s Assessment unit. ACE is delivered in the community and is staffed by 2.52 WTE band 6 children’s community nurses working between 09.00–21.00 7 days a week. Once a CYP has been accepted into the service the clinical responsibility lies with the Consultant Paediatrician at the acute Trust. CYP have 24 hour access to the Children’s Unit at the acute hospital during their care. The ACE project, the first of its kind in the UK, provides an alternative to a hospital referral or admission for common acute conditions like asthma. Individual clinical pathways have been developed with GPs, nurse practitioners, nurses, pharmacists and paediatricians and are based on best available evidence, national guidance and local clinical agreement. In addition to acute management the team deliver a ‘care bundle’ e.g. for asthma/wheeze this includes support with inhaler delivery, monitoring effectiveness of treatment, education in managing future episodes, identifying deterioration and smoking cessation advice. Results Evaluation of the first 9 months has shown that the service is safe and that care can be delivered out of hospital. Between the 4 December 2017 and 17 September 2018 the service took 210 referrals and saved 194 bed days with no adverse events. Conclusion ACE has increased productivity, improved patient experience, reduced costs and ensured secondary care services are available for those children who require them. We have also developed competencies of a workforce able to work across acute and community settings. Robust clinical governance processes have resulted in no adverse events since service launch in December 2017. The service delivery model is simple and can be easily replicated in other areas providing acute care for CYP.