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Identifying and prioritising future interventions with stakeholders to improve paediatric urgent care pathways in
Emma King1, Emma France2, Cari Malcolm3
1Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK emma.king@stir.ac.uk.
Insights
Parents and health professionals seek patient-centered, community-based interventions as alternatives to current pediatric urgent care. Key priorities include enhancing community pediatric skills, in-community assessment, and integrated children
Area of Science:
- Pediatric healthcare delivery
- Health services research
- Public and patient involvement in research
Background:
- Current unscheduled pediatric urgent care pathways face challenges.
- There is a need to identify alternative interventions from the perspectives of parents and health professionals.
- Public and patient involvement (PPI) is crucial for developing effective healthcare solutions.
Purpose of the Study:
- To identify and prioritize interventions for unscheduled pediatric urgent care.
- To gather perspectives from parents and health professionals on alternative care pathways.
- To inform the development of patient-centered, community-based pediatric healthcare.
Main Methods:
- A sequential mixed-methods study (FLAMINGO) involving data linkage of urgent pediatric admissions (2015-2017).
- Qualitative interviews with 48 health professionals and 21 parents experiencing urgent short-stay hospital admissions.
- Public and patient involvement throughout, culminating in a stakeholder intervention prioritization event.
Main Results:
- Seven potential interventions were identified and prioritized by stakeholders.
- Top priorities included enhancing community pediatric skills, in-community assessment of unwell children, and creating holistic children's hubs.
- Barriers to implementation include resources, staffing, and rurality.
Conclusions:
- Health professionals and families desire patient-centered, community-based interventions.
- Prioritized interventions focus on improving care delivery within the community setting.
- Future pediatric urgent care models should align with patient and family-identified outcomes.
Objectives:
To identify and prioritise interventions, from the perspectives of parents and health professionals, which may be alternatives to current unscheduled paediatric urgent care pathways.
Design:
FLAMINGO (FLow of AdMissions in chIldren and youNG peOple) is a sequential mixed-methods study, with public and patient involvement (PPI) throughout. Data linkage for urgent admissions and three referral sources: emergency department, out of hours service and general practice, was followed by qualitative interviews with parents and professionals. Findings were presented and discussed at a stakeholder intervention prioritisation event.
Setting:
National Health Service in Scotland, UK.
Participants:
Quantitative data: children with urgent medical admission to hospital from 2015 to 2017. Qualitative interviews: parents and health professionals with experiences of urgent short stay hospital admissions of children. PPI engagement was conducted with nine parent-toddler groups and a university-based PPI advisory group. Stakeholder event: parents, health professionals and representatives from Scottish Government, academia, charities and PPI attended.
Results:
Data for 171 039 admissions which included 92 229 short stay admissions were analysed and 48 health professionals and 21 parents were interviewed. The stakeholder event included 7 parents, 12 health professionals and 28 other stakeholders. Analysis and synthesis of all data identified seven interventions which were prioritised at the stakeholder event: (1) addressing gaps in acute paediatric skills of health professionals working in community settings; (2) assessment and observation of acutely unwell children in community settings; (3) creation of holistic children's 'hubs'; (4) adoption of 'hospital at home' models; and three specialised care pathways for subgroups of children; (5) convulsions; (6) being aged <2 years old; and (7) wheeze/bronchiolitis. Stakeholders prioritised interventions 1, 2 and 3; these could be combined into a whole population intervention. Barriers to progressing these include resources, staffing and rurality.
Conclusions:
Health professionals and families want future interventions that are patient-centred, community-based and aligned to outcomes that matter to them.
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