Reducing Unnecessary Readmissions to Paediatric Assessment Units
Paediatric QI Fellow Project Interim Report, January 2017
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Background
Anecdotally it was noticed that children were frequently returning following discharge from paediatric assessment units across Wessex. Many of these reattendances did not seem clinically necessary and I wanted to explore why this was happening and look for ways to reduce this.

Project Aims (what are we trying to accomplish)
Reduce unnecessary readmissions to paediatric assessment units whilst ensuring necessary readmissions re-present in a timely manner.

Brief description including setting (e.g. ward based, community etc)
Regional gathering of data from all paediatric assessment units in Wessex as well as exploring views of assessment unit staff and most importantly, parents and carers.
 
How will we know a change is an improvement? (what are your measures?)
  • Readmission rates
  • Appropriateness of re-presentations (including objective measures such as length of stay, escalation to HDU/ PICU, etc)
  • Parent, carer and assessment unit staff feedback

Progress to date
  • All assessment units in Wessex have been visited (Basingstoke, Winchester, Salisbury, Portsmouth, Poole, Dorchester, IOW & Southampton) and data collected.
  • Admission figures were collected for October 2016 (unavailable at Basingstoke & IOW) showing re-presentations via open access represented between 5% and 24% of children seen. Overall, >80% of these children were again discharged within 4 hours crudely suggesting re-attendance was not clinically necessary.
  • Information was also collected about open access facilities, safety netting resources available and staff views about optimal safety netting.
  • Questionnaires are currently being distributed to all parents and carers who present to the assessment unit to seek views about safety netting.
  • A second questionnaire is also being distributed to parents & carers who bring their child back via open access looking for factors involved and to highlight areas for improvement.

Patient Involvement
  • Yes – parent/carer feedback relating to safety netting & reasons for re-presentation.
  • Changes/ improvement will involve consultation & co-design with parents, carers +/- young people.

Next steps
  • Collate all data from assessment unit visits & disseminate across region
  • Complete parent questionnaires & analyse findings to identify areas of improvement
  • Snapshot analysis of safety netting inc documentation of advice & any written info given
  • Changes will be based upon findings from the above, with a run chart of re-admission rates

Project lead, role and contact details
Seb Gray, QI Fellow - sebastiangray@hotmail.com, @SebJGray

Useful Resources