Abstract
BackgroundIncreasing attendances by children (aged 0–16 years) to United Kingdom Emergency Departments (EDs) challenges patient safety within the National Health Service (NHS) with health professionals required to make complex judgements on whether children attending urgent and emergency care services can be sent home safely or require admission. Health regulation bodies have recommended that an early identification systems should be developed to recognise children developing critical illnesses. The Pennine Acute Hospitals NHS Trust Paediatric Observation Priority Score (PAT-POPS) was developed as an ED-specific tool for this purpose. This study aims to revise and improve the existing tool and determine its utility in determining safe admission and discharge decision making.Methods/designAn observational study to improve diagnostic accuracy using data from children and young people attending the ED and Urgent Care Centre (UCC) at three hospitals over a 12 month period. The data being collected is part of routine practice; therefore opt-out methods of consent will be used. The reference standard is admission or discharge. A revised PAT-POPs scoring tool will be developed using clinically guided logistic regression models to explore which components best predict hospital admission and safe discharge. Suitable cut-points for safe admission and discharge will be established using sensitivity and specificity as judged by an expert consensus meeting. The diagnostic accuracy of the revised tool will be assessed, and it will be compared to the former version of PAT-POPS using ROC analysis.DiscussionThis new predictive tool will aid discharge and admission decision-making in relation to children and young people in hospital urgent and emergency care facilities.Trial registrationNIHR RfPB Grant: PB-PG-0815-20034.ClinicalTrials.gov: 213469. Retrospectively registered on 11 April 2018.
Highlights
Increasing attendances by children to United Kingdom Emergency Departments (EDs) challenges patient safety within the National Health Service (NHS) with health professionals required to make complex judgements on whether children attending urgent and emergency care services can be sent home safely or require admission
This new predictive tool will aid discharge and admission decision-making in relation to children and young people in hospital urgent and emergency care facilities
The National Patient Safety Agency and the National Institute for Health and Clinical Excellence supported the conclusions of The Confidential Enquiry into Maternal and Childhood Health (CEMACH) report “Why Children Die: a pilot study (2006)” [5] which highlighted death may be prevented if clinicians were better at recognising deterioration
Summary
Increasing attendances by children (aged 0–16 years) to United Kingdom Emergency Departments (EDs) challenges patient safety within the National Health Service (NHS) with health professionals required to make complex judgements on whether children attending urgent and emergency care services can be sent home safely or require admission. Healthcare professionals make judgements on whether children attending EDs can be sent home safely or require admission to a hospital ward or admission to an observation and assessment area These judgements require a complex assessment of the child’s health and an estimation of the potential for improvement or deterioration. Amongst those presenting each year there are some sick children and young people, and detection requires health care professionals to have skills in recognising them. The report recommended that early identification systems to recognise children developing critical illness should be used as the UK continues to perform poorly against other European countries in relation to childhood mortality [6] calls to introduce these nationally have continued
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