Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan;11(1):e001561.
doi: 10.1136/bmjoq-2021-001561.

Improving paediatric flow in an UK Paediatric Assessment Unit

Danning Li  1 , Movin Abeywickrema  2 , Sharvari Vadeyar  2 , Abigail Ward  2 , Thomas Abberton  2 , Justina Rweyemamu  2
Affiliations

Improving paediatric flow in an UK Paediatric Assessment Unit

Danning Li et al. BMJ Open Qual. 2022 Jan.

Abstract

The 2010 Royal College of Paediatrics and Child Health (RCPCH) guidelines for acute paediatric services set standards for time to senior review for paediatric medical admissions in the UK as tier two doctor (registrar) review within 4 hours and consultant review within 14 hours. Our aim was to implement these standards in our unit through increasing proportions of reviews within these timeframes and measuring the impact on patient flow. Four quality improvement cycles were completed between March 2018 and March 2020 capturing data from 288 patient data sets. Recommendations included the extension of consultant on-site availability out of routine working hours (after cycle 1), highlighting patients awaiting consultant review during team handover (after cycle 2), and improving tier two doctor rostering (after cycle 3). After highlighting patients for consultant priority review, the proportion of patients seen within 14 hours improved from 53.3% (cycle 2) to 95% (cycle 3, p=0.005). Improved tier two doctor cover increased the proportion meeting registrar review within 4 hours from 82.9% (cycle 3) to 96.2% (cycle 4, p=0.028). A large proportion of paediatric patients were managed and discharged at tier two doctor level (65.6% over cycles 1-4). An inverse correlation was seen (R=-0.587) between time to discharge and the number of tier two doctors on shift (cycle 4). The interventions conducted demonstrated significant improvement in proportions of paediatric patients seen within the RCPCH timeframes. Adequate tier two doctor staffing is a priority for prompt review and discharge of acute paediatric patients. Future work aims to consider factors such as nursing rostering, bed management and the impact of COVID-19 on paediatric flow.

Keywords: continuous quality improvement; efficiency; length of stay; organizational; paediatrics; patient discharge.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Impact of registrar rostering on time to be seen by a registrar doctor and time until discharge.
Figure 2
Figure 2
Driver diagram of Paediatric Assessment Unit (PAU) flow, and cycle interventions.
Figure 3
Figure 3
Proportions of patients reviewed within the Facing the Future standards across five plan, do, study and act cycles.
See this image and copyright information in PMC

References

    1. Paling S, Lambert J, Clouting J, et al. . Waiting times in emergency departments: exploring the factors associated with longer patient waits for emergency care in England using routinely collected daily data. Emerg Med J 2020;37:emermed-2019-208849. 10.1136/emermed-2019-208849 - DOI - PMC - PubMed
    1. RCPCH.ac.uk . Facing the future: standards for acute General paediatric services, 2015. Available: https://www.rcpch.ac.uk/sites/default/files/2018-03/facing_the_future_st... [Accessed 29 Nov 2020].
    1. RCPCH.ac.uk . Facing the future audit 2017, 2017. Available: https://www.rcpch.ac.uk/sites/default/files/2018-04/Facing%20the%20Futur... [Accessed 29 Nov 2020].
    1. Kendrew-Jones T, Farquharson S, Stewart E. G112 (P) are we facing the future? a review of acute General paediatric admissions at a regional paediatric Hospital. Arch Dis Child 2020;105. 10.1136/archdischild-2020-rcpch.89 - DOI
    1. Ramsden L, McColgan MP, Rossor T, et al. . Paediatric outcomes and timing of admission. Arch Dis Child 2018;103:611–7. 10.1136/archdischild-2017-314559 - DOI - PubMed