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Avoiding inappropriate paediatric admission: facilitating General Practitioner referral to Community Children's
Richard G Kyle1, Michele Banks, Susan Kirk
1School of Nursing, Midwifery and Health, University of Stirling (Highland Campus), Centre for Health Science, Old Perth Road, Inverness IV2 3JH, UK. richard.kyle@stir.ac.uk
Insights
Facilitating General Practitioner (GP) referrals to Community Children
Area of Science:
- Pediatric Healthcare
- Community Nursing
- Healthcare Management
Background:
- Rising emergency admissions for children in England necessitate innovative care models.
- Community Children's Nursing Teams (CCNTs) offer home-based acute care to reduce hospitalizations.
- Understanding GP referral facilitators is crucial for optimizing CCNT services.
Purpose of the Study:
- To identify key facilitators for General Practitioner (GP) referrals to Community Children's Nursing Teams (CCNTs).
Main Methods:
- Qualitative study involving semi-structured interviews with 39 health professionals (GPs, CCNs, pediatricians, commissioners, managers).
- Interviews conducted in three Primary Care Trusts in North West England.
- Thematic analysis of qualitative data using the Framework approach.
Main Results:
- Five primary facilitators for GP referral to CCNTs were identified.
- Key facilitators include CCN/CCNT visibility, clear clinical governance, investment in CCNT roles, accessibility, and supportive financial frameworks.
- GP confidence in CCN competence and rapid escalation pathways are essential.
Conclusions:
- Building GP confidence in CCN competence is vital for safe home management of acutely ill children.
- Clear clinical governance protocols and incremental development strategies can enhance GP referrals to CCNTs.
- Optimizing GP referral pathways can reduce avoidable hospital admissions and improve child and family well-being.
Background:
Children's emergency admissions in England are increasing. Community Children's Nursing Teams (CCNTs) have developed services to manage acutely ill children at home to reduce demand for unscheduled care. Referral between General Practitioners (GPs) and CCNTs may reduce avoidable admissions and minimise the psychosocial and financial impact of hospitalisation on children, families and the NHS. However, facilitators of GP referral to CCNTs are not known. The aim of this study was to identify facilitators of GP referral to CCNTs.
Methods:
Semi-structured interviews with 39 health professionals were conducted between June 2009 and February 2010 in three Primary Care Trusts served by CCNTs in North West England. Interviewees included GPs, Community Children's Nurses (CCNs), consultant paediatricians, commissioners, and service managers. Qualitative data were analysed thematically using the Framework approach in NVivo 8.
Results:
Five facilitators were identified: 1) CCN/CCNT visibility; 2) clear clinical governance procedures; 3) financial and organisational investment in the role of CCNTs in acute care pathways; 4) access and out of hours availability; 5) facilitative financial frameworks.
Conclusion:
GPs required confidence in CCNs' competence to safely manage acutely ill children at home and secure rapid referral if a child's condition deteriorated. Incremental approaches to developing GP referral to CCNTs underpinned by clear clinical governance protocols are likely to be most effective in building GP confidence and avoiding inappropriate admission.
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