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Substituting community children's nursing services for inpatient care: a case study of costs and effects
Peter Callery1, Richard G Kyle2, Helen Weatherly3
1School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Insights
Community Children's Nursing Teams (CCNT) provide effective alternatives to hospitalization, shortening care pathways and reducing NHS costs. Patient satisfaction with CCNT care remained high after service reconfiguration.
Area of Science:
- Pediatric Healthcare Services
- Health Services Research
- Nursing Care Models
Background:
- Relocation of acute general pediatric inpatient services necessitated service reconfiguration.
- Extension of the pediatric Emergency Department and Observation and Assessment Unit (ED/OAU) aimed to enhance acute care capacity.
- Community Children's Nursing Teams (CCNT) play a crucial role in providing ongoing care for children outside hospital settings.
Purpose of the Study:
- To compare pediatric patient pathways to and through Community Children's Nursing Team (CCNT) care.
- To evaluate the impact of service reconfiguration on NHS costs associated with CCNT care.
- To assess patient satisfaction with CCNT services before and after significant changes in acute pediatric service delivery.
Main Methods:
- A case study approach was employed, utilizing routinely collected activity and staffing data from the CCNT.
- Parental questionnaires assessed healthcare service utilization and satisfaction pre- and post-service reconfiguration (n=221 pre, n=210 post).
- Comparative analysis of healthcare service use and associated NHS costs was conducted.
Main Results:
- The mean number of services used by children before CCNT referral decreased significantly (2.8 to 1.6).
- Inpatient admissions during CCNT care fell from 6% to 2%, and ED attendances dropped from 37% to 16%.
- A 25% reduction in CCNT care costs and a 55% decrease in overall NHS costs were observed, with 85% patient satisfaction maintained.
Conclusions:
- Community Children's Nursing Teams (CCNT) effectively serve as an alternative to hospitalization following acute pediatric service reconfiguration.
- The reconfiguration shortened children's pathways to CCNT care, demonstrating improved service integration.
- The study highlights reduced CCNT and overall NHS costs alongside sustained high levels of patient satisfaction.
Objective:
To compare children's pathways to and through Community Children's Nursing Team (CCNT) care, and NHS costs, before and after relocation of inpatient services and extension of a paediatric Emergency Department and Observation and Assessment Unit (ED/OAU).
Design:
Case study. Routinely collected data on activity and staffing were provided by the CCNT. Parents completed questionnaires about their child's use of healthcare services and satisfaction with care preservice reconfiguration (n=221) or postreconfiguration (n=210). The cost of service use was compared prereconfiguration and postreconfiguration.
Patients:
Children referred to CCNT care.
Main Outcome Measures:
Healthcare service use and associated costs, satisfaction with CCNT care.
Results:
The mean number of services used before referral to the CCNT reduced from 2.8 to 1.6, and the proportion using only one service increased from 26% (n=58) to 61% (n=128). Inpatient admission during CCNT care reduced from 6% (n=13) to 2% (n=4), and ED attendance from 37% (n=79) to 16% (n=31). There was a considerable fall (25%) in the cost of CCNT care, and a sharp fall (55%) in the average overall NHS cost of care. CCNT care was rated 'excellent' or 'very good' by 85% of respondents both prereconfiguration and postreconfiguration.
Conclusions:
A CCNT provided an alternative to hospitalisation when acute general paediatric services were reconfigured to substitute for a relocated hospital. Children's pathways to CCNT care were shortened. The average cost of CCNT care and overall NHS cost were lower following reconfiguration. Satisfaction remained high throughout.
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