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New child care standards could cut hospital admissions

Standards stress good links with GPs

Adrian O'Dowd

Thursday, 23 March 2017

Experts have published care standards to help deal with growing numbers of children and young adults attending emergency departments and to ensure they are treated appropriately.

The Royal College of Paediatrics and Child Health’s new Standards for Short Stay Paediatric Assessment Units (SSPAUs) were published today.

The college said the number of children and young people (15 years and under) being seen in hospital emergency departments in England rose by 7.6% between 2014-15 and 2015-16 – the equivalent of 4.4 million attendances.

There were now two and a half times more under 15-year-olds at emergency departments than over 80-year-olds in England.

While GPs remained the most widely used and trusted source of advice for the parents of sick children, said the college, an increasing proportion of children were admitted to hospital through emergency departments and not through their GP.

In 2015-16, almost two thirds (62%) of all emergency admissions for infants, children and young people were via emergency departments compared to 60% in 2006-07, while the numbers being referred by a GP fell from 24% to 22% over the same period.

This demand led to more pressure on hospitals, said the college, but at the same time, the number of short stay paediatric assessment units across the UK had increased from 144 to 178 in the last eight years.

These short stay units – hospital based facilities in which children with acute illness, injury or other urgent conditions can be assessed, investigated and treated with an expectation of discharge in less than 24 hours – were becoming essential in treating children quickly and effectively but they should provide consistent care across the UK, said the college.

Currently, these units operated in various ways with different types of staff working there, different rostering arrangements, they were based at various locations within hospital premises, and had different opening times.

To try and standardise care, the college’s new UK-wide standards, cover governance of units; the environment and hours of operation; recognition and management of a deteriorating child; promotion of ambulatory and community based care; supporting services; communication with children, young people and families; and staffing and training.

The standards recommend that:  

  • all children and young people accessing the unit must have a standardised initial assessment within 15 minutes of arrival
  • a standard operating policy must be in place with a named senior paediatrician and named senior children’s nurse responsible for management and coordination of the service
  • a paediatric consultant is readily available on the hospital site at times of peak activity of the unit and can attend within 30 minutes
  • all clinical staff have appropriate, up-to-date paediatric resuscitation training
  • the unit must have good links to services in primary and secondary care.

Dr John Criddle, clinical lead for the standards, said: “Our priority is to make sure unwell children are seen promptly by the right healthcare professional in the most appropriate setting.

“It is unsettling for the child and the family if they are admitted for less than a day, when in fact they could be treated just as well in a short stay unit. It may reduce family disturbance all round, result in more effective treatment and has the potential to reduce costs due to fewer admissions and shorter length of stay.

“Already hundreds of SSPAUs across the country are providing high quality care to thousands of children every day. We hope that these clear set of standards will help SSPAUs become even more effective.”

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