Paper 5.0 SHAPING A HEALTHIER FUTURE PAEDIATRIC TRANSITION: ANTICIPATED BENEFITS OF THE TRANSITION AND PROPOSED MODEL OF CARE.

Transcription

1 SHAPING A HEALTHIER FUTURE PAEDIATRIC TRANSITION: ANTICIPATED BENEFITS OF THE TRANSITION AND PROPOSED MODEL OF CARE December 2015 Version 2.2 Paper 5.0 1

2 Purpose This document sets out the proposed new paediatric model of care for Ealing and the rest of NW London from 30 th June It covers: 1. The case for change 2. The anticipated benefits for children from these changes 3. New paediatric model of care at Ealing Hospital from 30 th June 2016; 4. Summary of transfer pathways which show how children will move between services; 5. Changes to paediatric model of care at other hospitals: Paediatric Assessment Unit (PAU). 2

3 Case for change and anticipated benefits arising from this change Ealing Hospital post-transition model of care from 30 th June 2016 Summary of transfer pathways Developing the North West London network of paediatric specialist care: Paediatric Assessment Units 3

4 Paediatric services in Ealing and across North West London need to change The issues identified with children s healthcare in NW London are: there are too few paediatric doctors to staff rotas in a safe and sustainable way staffing levels are variable out-of-hours some children s care could be better provided at home or in a clinic in hospital that doesn t require an overnight stay sometimes referred to as ambulatory care. For high quality care, units need to be staffed properly. This could be done by concentrating in-patient paediatric care and neonatal care into a smaller number of units. On 1st July 2015, the maternity ward closed at Ealing Hospital, along with the Special Care Baby Unit (SCBU). SCBU was staffed by neonatologists who were transferred to other units in NW London. Without neonatologists present at Ealing Hospital, the paediatrics service is not robust for long term operation as these services shared clinical staff and rotas between them. 4

5 Changes to paediatric services in Ealing and across NW London will happen on 30th June 2016 On 20th May 2015, Ealing Clinical Commissioning Group (CCG) Governing Body set a date of 30th June 2016 for the closure of the children s ward at Ealing Hospital. This is in line with the London Clinical Senate report which stated " the Review Team would be concerned if, because of a lack of appropriate planning and agreement to provide additional capacity within the receiving hospitals, the eventual transition is delayed beyond June Plans to transition paediatric services include: implementing the new Rapid Access Clinic at Ealing Hospital (opened November 2015) enhancing Ealing s Urgent Care Centre with additional paediatric training ensuring additional capacity is in place in other children s wards across NW London pathways for the assessment and transfer of children who arrive at Ealing Hospital requiring A&E treatment closure of Ealing Hospital children s ward. 5

6 A significant range of benefits for children in Ealing and across North West London will arise from these changes These changes will: Improve the quality of care patients receive Improve patients' access to services in the community Improve the capacity and capability of our clinical workforce Improve the environment in which children are seen 6

7 These changes will deliver a wide range of benefits for children receiving healthcare in Ealing, and across North West London These benefits will apply to all children, wherever they live or whichever hospital they attend, resulting from a networked model of care between multiple organisations and healthcare professionals. Improving the quality of care patients receive By working together, clinicians in NWL have developed a unified and comprehensive model of care delivering high quality services to children, wherever they live or whichever hospital they use New models of care such as the Rapid Access Clinic will be in place to give a service to children who would otherwise have had to attend an A&E department New paediatric assessment units in the five major hospitals in NWL will provide a better, higher quality service for all children, including those from Ealing Improving patients' access to services in the community An expanded and improved provision of community paediatrics services to help children receive care closer to their homes Improving the capacity and capability of our clinical workforce Developing stronger and larger teams of clinicians to deliver care for children both in hospital and in the community Extended evening and weekend availability of paediatric consultants in NW London, leading to more effective clinical decision making and better outcomes for patients (e.g. enhanced quality, fewer admissions and reduced length of stay) Increasing the number of paediatric nurses at all NW London providers, including the community Better training and development opportunities for paediatric clinical staff in all NW London providers Improving the environment in which children are seen Appropriate capital building works are taking place in all hospitals which are expecting increased numbers of patients. This will mean an improved patient experience at A&E departments and in all areas where children are seen. 7

8 Case for change and anticipated benefits arising from this change Ealing Hospital post-transition model of care - from 30th June 2016 Summary of transfer pathways Developing the North West London network of paediatric specialist care: Paediatric Assessment Units 8

9 Current provision of Children s services in the Borough of Ealing As of December 2015, the following locations provide the majority of care to children within the borough of Ealing as follows: GP Practices The majority of care provided to children is undertaken by their GP Ealing has 79 GP practices, all of which provide care and support to children Community & Mental Health A full range of community and mental health children s services within the borough Ealing Hospital 24/7 Urgent Care Centre A&E department Children s ward - 16 paediatric inpatient ward beds of which on average, are generally in use Daycare and outpatient paediatric services The majority of children s care in Ealing is provided by GPs and community / mental health services. These services remain unaffected and the planned changes outlined on the following pages only considers hospital based care. 9

10 After the 30 June 2016 service change, 73% of the current paediatric activity provided at Ealing Hospital will remain Some of this activity will also remain in the Rapid Access Clinic at Ealing Hospital Chart showing the proportion of activity that will remain at Ealing Hospital post-transition (2014/15 actuals) A&E, 5,979, 19% Outpatient, 5,191, 16% In-patient, 2,607, 8% UCC In-patient A&E Outpatient Staying in Ealing Moving elsewhere UCC, 17,983, 57% The vast majority of current paediatric activity (73% of total) will remain at Ealing Hospital posttransition An enhanced urgent care centre will continue to treat the vast majority of children who require urgent care Outpatients and daycare services will remain at Ealing Hospital and children will continue to receive their usual level of this care A new Rapid Access Clinic is now seeing children who would previously have gone to an A&E Changes are planned to how emergency care is delivered to children in NW London 10

11 After 30 June 2016, Ealing Hospital will continue to provide extensive services to children Proposed Ealing Hospital paediatric model of care Retained services New services Closed services Paediatric urgent care provided by the Urgent Care Centre (UCC); Existing general and paediatric Outpatient services (i.e. clinics on site plus community delivery of diabetes, asthma); Non-emergency, low-acuity day-care services such as surgery, Liaison CAMHS and physiotherapy Consultant-led paediatric Rapid Access Clinic (RAC): 7 day, GP referral-only service. Aim is to reduce A&E attendance by providing GPs with an alternative to referring to A&E. Timed same-day/ next-day appointments with paediatric specialists offered to patients. This service will start in Winter Paediatric in-patient Children s specialist A&E care 11

12 Ealing Paediatric Community Services Ealing community services will continue to provide local care for all children who need it. Care for children with chronic conditions this will continue to be provided in Ealing for children with chronic conditions. The SaHF programme will make use of existing networks and separately engage lead clinicians for children with chronic conditions to map the pathways that provide continuity of care, from community to acute hospital and then back to community. Continuous safeguarding of children is central to these pathways. Specifically, the programme will focus on the following chronic conditions: Diabetes; Asthma; Cystic Fibrosis; Epilepsy; Children with disabilities. Work is underway to improve the quality of paediatric out of hospital services in Ealing. Initiatives include: Connecting Care for Children pilot in Southall and Acton - this service is designed to provide secondary care-type paediatric services in a community setting, reducing admissions and re-admissions, and upskilling GPs in the provision of paediatric care. Relocation of the Children s Community Nursing Team and integration with existing day-care services at Ealing Hospital. Relocating the community team will enable paediatric services to be tailored to patient need as patients can be provided with a home visit or asked to attend the day-care service as needed (rather than these functions being fulfilled by separate services). 12

13 Ealing Child and Adolescent Mental Health Services (CAMHS) Ealing CAMHS will continue to operate as normal and will receive referrals from both Ealing Hospital and Receiving Trusts. Ealing CAMHS will continue to provide emergency cover to Ealing Hospital UCC and A&E. Ealing residents requiring emergency CAMHS care on admission to an in-patient unit elsewhere in North West London will receive care from the local CAMHS service. They will then be referred to the Ealing CAMHS for follow-on care, as happens currently. A&Es at receiving sites will be able to refer directly to Ealing CAMHS if a patient is discharged and requires follow-on care. In line with Future in Mind, CAMHS transformation plan sets out 8 priorities as new investment, including; 1. Assessment of needs, services and interdependencies to refine future services for Co-production with local organisations to support children and young people 3. Workforce development and training 4. Development of a Community Eating Disorder Service 5. Transforming Pathways movement away from tiered services 6. Enhanced support for learning disabilities and neuro development disorders 7. Crisis and urgent care pathways 8. Embedding Future in Mind programmes locally, including children and young people IAPT (Improving Access to Psychological Therapies) 13

14 Ealing Hospital Paediatric Day Care and Out-patient Services The vast majority of daycare and outpatient services will remain at Ealing hospital: Day Care Unit (e.g. blood transfusions for thalassaemics, low risk day case allergy challenges, low risk endocrine stimulation tests); Existing general and paediatric Out-patient services (i.e. clinics on site plus community delivery of diabetes, asthma); Day Surgery Unit for children requiring local anaesthesia Sickle Cell and Thalassemia Service; Paediatric Physiotherapy; Paediatric Speech and Language Therapy; Paediatric Orthopaedics (mainly trauma follow-up); Adolescent Sexual Health Services; Liaison Children and Adolescent Mental Health Services Visiting Tertiary Referral Specialist Paediatric Clinics. The Ealing Community Children s Nursing Service will move back to Ealing Hospital and will be co-located with the Day Care Unit. 14

15 Ealing Hospital Urgent Care Centre will continue and be enhanced More than half (57%) of the paediatric activity which is currently delivered at Ealing Hospital is done so through the Urgent Care Centre This service will remain in place so that children (and adults) can continue to receive their urgent care needs at this unit Work is underway with the UCC provider to build additional paediatric capacity and capability of the service so that a higher proportion of children can be managed safely on-site. Initiatives include : the appointment of a GP paediatric specialist within the UCC and; a review of paediatric competences for all staff within the UCC and comprehensive training support As the provider of A&E and other support services at Ealing Hospital, London North West Healthcare Trust will continue to supply clinical governance and emergency backup to the service. 15

16 A new Rapid Access Clinic will assist GPs to facilitate urgent care to children The Rapid Access Clinic (RAC) is a seven day, GP-referral only service designed to ensure early specialist paediatric input and provide GPs with an alternative to referring children requiring non-urgent care to A&E. Objectives include: To improve patient experience of care by ensuring that children receive treatment in a setting more appropriate to their condition. To provide Ealing residents with fast local access to specialist paediatric opinion. To reduce pressure on the Ealing Hospital A&E. Key features of the service: 7 day, GP referral-only service Timed same-day/ next day appointments Co-located with the current Ealing Day Care Unit and run in parallel Run by a consultant and supported by paediatric nursing and junior doctors The service is supported by a Consultant-led telephone advice service 16

17 The Rapid Access Clinic could reduce the volume of Ealing A&E activity transferring elsewhere 1,379 (23.1%) of children attending A&E could receive care at Ealing Hospital as a result of the RAC It is anticipated to open up the service to UCC referrals, further increasing the number of children who could use the service This would reduce the number of patients going to A&E at other hospitals Chart to show the proportion of current <16 A&E activity at Ealing Hospital that would be suitable for care at the RAC 1169, 19.6% 1169, 19.6% 1379, 23.1% 2262, 37.8% Initial RAC cohort A proportion of this activity could also be suitable for the RAC in the future <16 GP Referrals to A&E - Discharged from A&E without ongoing treatment <16 A&E activity referred from UCC <16 GP Referrals to A&E - Admitted or Other Disposition Other <16 A&E activity (e.g. LAS conveyances direct to A&E) 17

18 On 30 June 2016, services which deliver emergency care to children will change From 30 June 2016, Ealing Hospital will no longer treat children who require specialist paediatric emergency care or an admission to a bed. This means that: Ambulances will take these children straight to an alternative major hospital where there the child will be assessed, treated and, if necessary, admitted The alternative major hospitals will be: The Hillingdon Hospital West Middlesex University Hospital St Mary s Hospital Northwick Park Hospital Chelsea and Westminster Hospital GPs can refer patients directly to alternative A&Es when they believe the child requires specialist emergency paediatric care The major hospital will liaise with Ealing community services, outpatients, mental health, GPs as necessary so that follow-up care can be provided locally If a parent brings a critically ill child to Ealing A&E they will be stabilised and transferred Prior to 30 June 2016 we will work with local families to develop clear guidelines and communications regarding these arrangements. 18

19 Ealing Hospital A&E department When inpatient paediatric services close: Paediatric 'blue light' ambulance conveyances will convey children directly to the nearest alternative paediatric receiving emergency department. Children (0-16 year olds) that attend Ealing Hospital A&E will be assessed, stabilised treated or transferred as necessary. Older children aged years will be individually assessed to determine the best place to treat them. Ealing Hospital A&E will continue to provide care to unstable children for whom unsupported transfer would represent a clinical risk. A&E clinicians are therefore required to maintain the competences required to treat children safely. This is enabled by the rotation of staff at the Northwick Park site. 19

20 Alternative Major Hospital Ealing Hospital Ealing Hospital From 30 June 2016, urgent and emergency services at Ealing Hospital will differ from how they are currently provided Ealing Hospital: current urgent and emergency paediatric model of care Blue light Walk-in GP referral GP Ealing Hospital: future urgent and emergency paediatric model of care Blue light* GP referral GP Walk-in UCC RAC A&E UCC PAU In-patients A&E Day-care / out-patients Day-care / out-patients CAMHS Community services General Practice and Community Pharmacists Referred to Ealing based services if required CAMHS Community services General Practice and Community Pharmacists 20

21 Case for change and anticipated benefits arising from this change Ealing Hospital post-transition model of care Summary of transfer pathways Developing the North West London network of paediatric specialist care: Paediatric Assessment Units 21

22 Safe closure of Ealing paediatric A&E and in-patient services relies on robust, proven pathways The Paediatric Project Delivery Board (PDB) developed pathways in close collaboration with London Ambulance Service, A&E consultants, Urgent Care Centre and Ealing Community services. The Majority of pathways are already operational at Central Middlesex Hospital (CMH), Charing Cross Hospital and Hammersmith Hospital and are proven to be safe. For example, UCC transfer protocols were developed for the CMH A&E closure and apply equally to paediatric transfers from Ealing UCC. Some new information sharing approaches may need to be developed Comprehensive testing of these pathways in shadow form will be undertaken prior to implementation. Pathway areas of focus: 1. Emergency pathways: London Ambulance Service / Children's Acute Transport Service re-direct away from Ealing Hospital; UCC to A&E transfer. 2. Non-emergency pathways: safeguarding referrals, repatriation of Ealing patients Rapid Access Clinic referrals, ongoing care of children with chronic conditions Pathways will be tested thoroughly in shadow-form prior to implementation. 22

23 A broad range of stakeholders were engaged during pathway development Key stakeholder organisations engaged London Ambulance Service Emergency Department Consultants Care UK Ealing Clinical Commissioning Group Other commissioning organisations Engagement process Best practice examples collated 1:1 interviews with key stakeholders Formal workshop with all partners Testing and iteration via the Project Delivery Board The LAS, A&E consultants from across NWL and Ealing UCC are all comfortable with what is being proposed. 23

24 A summary of standard paediatric pathways TP1.1 Ealing UCC transfer (initial assessment, part 1 of 3) TP1.2 Ealing UCC transfer (paediatric assessment, part 2 of 3) TP1.3 Ealing UCC transfer (specialty assessment, part 3 of 3) TP2.1 Repatriation of Ealing Borough Child from NWL SCBU/NICU TP2.2 Repatriation of Ealing Borough Child from NWL ED TP2.3 Repatriation of Ealing Borough Child from NWL Ward/PAU TP2.4 Access to and treatment in Ealing Rapid Access Clinic TP2.5 CAMHS TP2.6 Safeguarding In conjunction with these pathways a series of repatriation pathways focusing on chronic conditions are being developed: CP1 Diabetes CP2 Disabilities CP3 Cystic Fibrosis CP4 Sickle cell anemia CP 5 Asthma 24

25 Next Steps Working with parents, children and young people, Trusts, London Ambulance Service and the Children s Acute Transport Service to develop comprehensive pathways. This will focus on: Detailed development and multi-stakeholder table top testing Testing before service transition Implementation 25

26 Case for change and anticipated benefits arising from this change Ealing Hospital post-transition model of care - from 30 th June 2016 Summary of transfer pathways Developing the North West London network of paediatric specialist care: Paediatric Assessment Units 26

27 Paediatric Assessment Unit (PAU): case for change There are currently a high proportion of children who are admitted to wards in NWL because they have been assessed in A&E but cannot be discharged home as they require further observation and/or assessment We are therefore introducing Paediatric Assessment Units at our major hospitals across North West London Children can be assessed, treated, and monitored for extended periods of time up to 24 hours These units are staffed by specialist paediatric doctors Analysis of NWL in-patient spells demonstrates that approximately 13% of patients who are admitted to a ward may be eligible for treatment in the PAU Methodology: Data on short-term in-patient spells of <24hrs NEL without critical care, as a proportion of the total in-patient spells (2014/15 data across 6 providers) At Ealing Hospital, the proportion of children who are currently admitted to the ward and may be eligible for treatment at a PAU is much higher at 43% The PAUs will therefore avoid admission to children's wards, will help to reduce demand on major hospital A&E services and decrease waiting times for children in A&E. 27

28 Intended outcomes of establishing PAUs Providing a more efficient clinical service for patients with self-limiting illness who require a period of observation and assessment Reducing demand on major hospital A&Es and therefore decreasing waiting times for children in A&E Ensuring patients are treated in a setting appropriate to their condition Ensuring patients do not stay in hospital longer than they need to Driving closer integration between hospitals and paediatric community services, resulting in earlier discharge, seamless ongoing care and reduced readmissions 28

29 Benefits of PAUs on provision of paediatric care in Ealing The PAUs are an essential element of the network of specialist paediatric care across NWL. In addition to the outcomes outlined on the previous slide, PAUs will benefit the Ealing population by: Ealing children who attend a major A&E can be referred directly into the associated PAU, if this is the right place for them to be treated. Analysis shows this could be up to 43% of Ealing children currently admitted to an inpatient ward. The Urgent Care Centre (UCC) in Ealing can refer to PAUs - The Ealing UCC will be able to access the NWL PAU network for both advice and information and to make referrals into any NWL PAU service. This will help ensure that children who present in Ealing are able to quickly access a paediatrician where required and that they are treated in an environment appropriate to their needs. Ensuring appropriate support for Ealing children with long term conditions - The NWL PAU network will provide support for children with long term conditions by establishing a clear link for advice, information and referrals between community services and paediatricians. There is also potential to develop paediatric passport for children who frequently attend the PAU so they are able to directly access the PAU when required, without a referral from a professional. 29

30 Development of our PAU model 1. Exploring best practice We have been working with the Royal College of Paediatrics and Child Health who are updating their guidance on Paediatric Assessment Units. The updated guidance is expected to be available in November 2016 and we will continue to work with them to ensure our proposed model is in line with national best practice. We have contacted other hospitals including the Royal Free, King s College and the Royal Derby to discuss their PAU models, exploring which aspects work well and areas for improvement. 2. Developing a NWL PAU specification Creating a guideline PAU specification to be adapted according to the local needs of children and existing services within CCG. Mapping the PAU patient pathway and agreeing referral routes into the service. This includes working with London Ambulance Service (LAS) to develop exclusion criteria for direct LAS referral pathway. 30

31 If admission to PAU is not appropriate NWL-wide PAU Pathway Urgent Care Centre Walk in Centre Community referral LAS The PAU will admit children and young people aged 0-16 years. GP referral Out of hours A&E Conditions particularly suitable for management in a PAU include: Referral to PAU via hotline Breathing difficulties Fever Diarrhoea Vomiting Abdominal pain Seizures Rash Head injury Non-intentional poisonings Consultant/ Registrar performs clinical triage PAU Registration Clinical checks: Take vitals, review patient and develop care plan Admission to hospital Discharge to GP Referral to community services Discharge home 31

32 Operational Features The PAU will be open 24 hours a day, 7 days a week. Patients will be able to stay in the PAU for a maximum of 23:59 hours before being discharged or admitted to the ward Where possible, the PAU should be co-located with the A&E department and run by the paediatric department. In hospitals where space constraints preclude co-location with A&E, appropriate numbers of staff should be in place to provide cover and ensure clinically safe transfer from A&E to the PAU All children and young people will be triaged on the phone via the hotline by a consultant as part of the referral process. Overnight, a registrar will perform the clinical triage over the phone. All children and young people who present at the PAU will be assessed by a paediatric nurse within 15 minutes of arrival, followed by a doctor within the first hour The PAU will offer direct access to a child friendly environment Parents and guardians will have a place to sit, access to refreshments and access to toilets separate from the public A&E toilets 32

33 Quality Standards Children with chronic conditions There are children and young people with chronic conditions, for example diabetes or leukaemia, who are likely to access the PAU service more regularly than those with one off or self-limiting episodes. children and young people with chronic conditions may also present at a PAU outside of their borough, and prevalence of this is likely to increase following the transition of paediatric inpatient services from Ealing Hospital. As such, a robust information management process must be in place to monitor these patients, and ensure continuity of care between the PAU and different parts of the health system, for example the patient s GP or local community services as appropriate. Safeguarding The service must demonstrate that it is meeting the standards outlined in the Children s Act (1989) and subsequent national guidance, which requires health care organisations to protect children by following national child protection guidance. It must be ensured that policies and procedures relating to safeguarding are adhered to, and that staff have completed appropriate training for their professional role, and are represented on the local safeguarding children s board. All staff working with children and young people must have undertaken an enhanced Criminal Records Bureau check. 33

34 Clinical assessment: Clinical screening: Clinical Screening and Assessment Pathway A telephone hotline will be used to accept all referrals into the PAU from other services The phone system will be operated by a consultant-level doctor in peak hours and by the duty registrar overnight. They will be responsible for performing an initial clinical triage over the phone Once admitted into the PAU, patients will be seen by a nurse within 15 minutes of arrival Patients will then be assessed by a doctor within an hour (includes nurse practitioner, emergency specialist, middle grade doctor) A registrar will see the child within 4 hours (if they are not the original doctor) and if required a paediatric consultant within 12 hours Referral from other services Contact PAU via hotline Consultant performs clinical triage over phone PAU Nurse (within 15 minutes) Doctor (within 1 hour) Registrar (within 4 hours) Paediatric Consultant (within 12 hours) Developed Care Plan Discharge to home or other services 34

35 Staffing in NWL PAUs Proposed Features: Ensuring staffing cover that is consistent with Royal College standards Efficient use of staff (shared across PAU and inpatients) Royal College Standard A consultant paediatrician is present 7 days a week, during peak hours Every child admitted to the PAU is seen by a healthcare professional with the appropriate competencies within 4 hours of admission Every child admitted to the PAU is seen by a consultant paediatrician* within 14 hours of admission, or more immediately according to illness severity and staff concerns At least two medical handovers every 24 hours are led by a consultant paediatrician* PAUs have access to the opinion of a consultant paediatrician* during all the hours they are open Comments Included in service specification Every patient must be seen within four hours by a middle grade doctor to review the care plan, progress and any change Paediatric Consultant to review within 12 hours This would include any patient in the PAU To be implemented as stated * or equivalent staff, associate specialist or speciality doctor who is trained and assessed as competent to work on the paediatric consultant rota. 35

36 Principles for the development of Key Performance Indicators (KPIs) for PAUs in NW London The PAU should have the same access to diagnostics as the existing paediatric inpatient department. This should include access to waiting time and activity data The provider will be expected to evidence compliance with national quality standards. The provider will set out local management and reporting arrangements with the commissioner particularly in relation to: Key clinical indicators Implementation of relevant best practice Patient experience Complaints, incidents and risk management Relevant clinical audit and national review of service Activity will be identifiable as having taken place at a specific PAU 36

37 Proposed KPIs for PAUs in NW London (1/2) KPI Threshold Method of measurement Consequence of breach Quality Indicators Every child admitted to the PAU is seen by a healthcare professional with the appropriate competencies within four hours of admission >95% PAU patient records Less effective clinical outcomes, longer stays in hospital setting All children seen in the PAU will be assessed, treated and discharged home or to the ward within a 24 hour period All children admitted to the PAU will fulfil the admission criteria At least two medical handovers every 24 hours are led by a consultant paediatrician Throughout the hours they are open, PAUs have access to the opinion of a consultant paediatrician The number and percentage of information passed to partners within 72 hours of discharge The number and percentage of information passed to GP within 48 hours of discharge The percentage of children and young people and their parents/ carers surveyed as being satisfied or very satisfied with the service >95% Data to be split by age, sex, ethnicity, month, day and time Longer stays in hospital setting >95% PAU patient records Inappropriate admissions >95% Staffing rotas Risk of inconsistent care and less effective clinical outcomes >95% Staffing rotas Less effective clinical outcomes, longer stays in hospital setting >95% Data to be split by age, sex, ethnicity, month, day and time >95% Data to be split by age, sex, ethnicity, month, day and time >80% To be agreed between commissioner and provider (e.g. survey) Less effective follow up in the community Less effectively follow up in the community Poor image, affecting future take up of PAU and related services The percentage of retention of nursing >86.5% Staff retention recorded and monitored Poor continuity of care and standards All staff will have up to date statutory and mandatory hand washing training >80% Staff retention recorded and monitored Poor standard of hygiene relates to increase risk of infection 37

38 Proposed KPIs for PAUs in NW London (2/2) KPI Threshold Method of measurement Consequence of breach Activity Indicators The number and percentage of children and young people treated in the PAU in each financial year N/A Data to be split by age, sex, ethnicity, referral method, month, day, time presenting condition and diagnosis N/A The number and percentage of children and young people that accessed the PAU via A&E The number and percentage of children and young people by discharge outcome The number of serious untoward and patient safety incidents recorded in each financial year Outcome indicators Reduction in breaches of the 4 hour A&E guideline waiting time Reduction in inpatient stays of 12 hours Reduction in the number of children and young people acute hospital inpatient admissions Reduction in the length of stay for children and young people acute hospital inpatient admissions Reduction in the readmission rates for children and young people hospital inpatient admissions N/A N/A N/A TBD TBD To be locally agreed To be locally agreed To be locally agreed Data to be split by age, sex, ethnicity, month, day and time Data to be split by age, sex, ethnicity, month, day and time Data to be split by age, sex, ethnicity, month, day and time Audit of clinical breaches/ exception reports Yearly and monthly comparisons following commencement of PAU Yearly and monthly comparisons following commencement of PAU Yearly and monthly comparisons following commencement of PAU Yearly and monthly comparisons following commencement of PAU N/A N/A N/A To be agreed at review meetings To be agreed at review meetings To be agreed at review meetings To be agreed at review meetings To be agreed at review meetings 38