Lessons from the COVID-19 pandemic in paediatric post-discharge care

Area of Science:

• Pediatric Healthcare
• Quality Improvement in Medicine
• Healthcare Management

Background:

• The COVID-19 pandemic necessitated rapid changes in outpatient pediatric services to minimize infection risks.
• A trainee-led clinic was established for continuity of care post-hospital discharge, serving as an alternative to ward attenders and reducing consultant-led clinic pressure.
• Initial implementation faced significant communication challenges in referral, booking, and follow-up processes.

Purpose of the Study:

• To reduce clinic non-attendance rates in a trainee-led pediatric outpatient service.
• To ensure timely outpatient reviews through effective communication among all stakeholders.
• To improve the overall efficiency and patient experience of post-discharge pediatric care.

Main Methods:

• Quality improvement methodologies were employed to understand and define communication issues.
• Consultation with service users identified four key communication criteria: indication, lead consultant, patient attendance, and outcome letter provision.
• Five interventions were tested using plan-do-study-act cycles over a 6-month period, with performance measured against the four criteria.

Main Results:

• Process improvements were observed, leading to meaningful changes at both patient and service levels.
• Performance increased from a baseline median of one to a minimum of three out of four communication criteria met per patient.
• A 50% reduction in the clinic's did not attend rate was achieved, with several patients experiencing management changes due to timely review.

Conclusions:

• Targeted interventions effectively addressed communication breakdowns in post-discharge pediatric care.
• The developed service is safer, more efficient, and improves continuity of care for children and young people.
• Ongoing feedback and focus on patient experience are crucial for future service development and patient-centered outcomes.