Paediatric Assessment Unit (PAU) Workshop

Transcription

1 Healthy London Partnership Children & Young People s Programme Paediatric Assessment Unit (PAU) Workshop 4 th March 2016

2 01 Professor Russell Viner Clinical Director Healthy London Partnership Children & Young Peoples Programme Transforming services for Children & Young People across London Transforming London s health and care together 2

3 Housekeeping 3

4 London Health Commission Healthy London Partnership The delivery arm of the London Health Commission 4

5 Goal London to be world s healthiest global city 10 programme aims from London Health Commission 5

6 What do children, young people and families think? I am worried about what will happen next year when I am too old for the children s clinic I want to know that my GP is experienced in caring for children Make sure the school can look after my son when he has an asthma attack I need rapid access to someone I can talk to when I feel depressed We need easier access to healthcare Services are not joined up 6

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8 Healthy London Partnership Children and Young People Programme Governance London Health Board Prevention Board Primary Care Board U and EC Board London Transformation Group (London s CCGs and NHS England) HLP C&YP Transformation Board CCG SRO (Martin Wilkinson) NHSE SRO (Will Huxter) CYP Clinical Director (Russell Viner) CCG Clinical Lead (Nicola Burbidge) SPG rep/s (Adam Doyle) DPH (Dagmar Zeuner) PHE (Marilena Korkodolis) DCSS (Linzi Roberts-Egan) CYP/family rep (Emma Rigby) Programme Manager (Tracy Parr) GP lead (Eugenia Lee) Accountable Mental Health Board Homelessness Board Specialised Services Board CYP Clinical Leadership Group CYP Commissioning Advisory Group Young People s Steering Group Information sharing/ endorsement Programme alignment Critical Care Clinical Leadership Group Primary Care Clinical Leadership Group Surgery Clinical Leadership Group Asthma Clinical Leadership Group Out of Hospital Care Clinical Leadership Group CAMHS Clinical Leadership Group CYP & Families Engagement throughout V0.6 8

9 Children and Young People Detailed Deliverables Priority A Develop Population Based Networks Priority B Reduce variation in care Priority B Reduce variation in care Priority D Improve commissioning Priority E Innovative Access Develop guidance for model of population based CYP networks including funding Understand data requirements to describe needs analysis in population based networks Develop data set and data dictionary to enable effective needs analysis CYP Work with SPGs to support development and implementation of population based network in each SPG dependent on local requirements Develop effective linkages between population based networks and HLP CYP programme Undertake evaluation of population based networks and disseminate learning (move to ) Undertake baseline mapping of provider landscape In depth analysis of CYP mortality based n data from CDOPs Develop standards of care Acute care (completed) Asthma (completed) Surgical networks (completed) HDU Out of hospital models of care Transition to adult services CAMHs (initial output completed) Diabetes Undertake baseline mapping of trusts against standards based on operational policies Devise and implement peer review process for acute trusts Acute care model annual report structure, model operational policies Asthma delivery plan at pan-london system, SPG level and CCG level Community pharmacy engagement plan Surgical networks support pilot in SW London linked into 11 DoS HDU develop funding and cocommissioning models CAMHS support CCGs in compiling transformation plans Support CCGs in CAMHS transformation plan implementation Out of hospital care Produce directory of models Undertake financial modelling ( ) Develop workforce strategy for all areas in conjunction with workforce programme Priority C Integration of care Develop integrated models of care for CYP (move to based on other workstream outputs) Develop model of primary care to meet needs CYP working with primary care programme Work with GP federation to support incorporation of models into delivery Undertake scoping of models in relation to CYP care (link in with Vanguard bids and work within HEE) ( ) Develop CYP commissioning programme (completed) Submit funding bid to HEE for first cohort Procure educational provider Recruit first cohort Support development of new commissioning models for CYP services ( ) Support CCGs to develop commissioning strategies to implement CAMHS task force Guidance on effective communication with CYP using new media on how to access services effectively Development of materials to illustrate when medical advice should be sought 9

10 Children and Young People Detailed Deliverables Priority A Develop Population Based Networks Priority B Reduce variation in care Priority B Reduce variation in care Priority D Improve commissioning Priority E Innovative Access Develop guidance for model of population based CYP networks including funding Understand data requirements to describe needs analysis in population based networks Develop data set and data dictionary to enable effective needs analysis CYP Work with SPGs to support development and implementation of population based network in each SPG dependent on local requirements Develop effective linkages between population based networks and HLP CYP programme Undertake evaluation of population based networks and disseminate learning (move to ) Undertake baseline mapping of provider landscape In depth analysis of CYP mortality based n data from CDOPs Develop standards of care Acute care (completed) Asthma (completed) Surgical networks (completed) HDU Out of hospital models of care Transition to adult services CAMHS (initial output completed) Diabetes Undertake baseline mapping of trusts against standards based on operational policies Devise and implement peer review process for acute trusts Acute care model annual report structure, model operational policies Asthma delivery plan at pan-london system, SPG level and CCG level Community pharmacy engagement plan Surgical networks support pilot in SW London linked into 11 DoS HDU develop funding and cocommissioning models CAMHS support CCGs in compiling transformation plans Support CCGs in CAMHS transformation plan implementation Out of hospital care Produce directory of models Undertake financial modelling ( ) Develop workforce strategy for all areas in conjunction with workforce programme Priority C Integration of care Develop integrated models of care for CYP (move to based on other workstream outputs) Develop model of primary care to meet needs CYP working with primary care programme Work with GP federation to support incorporation of models into delivery School nursing Use of pharmacies to support asthma care Learning from asthma deaths Undertake scoping of models in relation to CYP care (link in with Vanguard bids and work within HEE) ( ) Develop CYP commissioning programme (completed) Submit funding bid to HEE for first cohort Procure educational provider Recruit first cohort Support development of new commissioning models for CYP services ( ) Support CCGs to develop commissioning strategies to implement CAMHS task force Guidance on effective communication with CYP using new media on how to access services effectively Development of materials to illustrate when medical advice should be sought 10

11 Background Information (1 of 2) A Paediatric Assessment Unit (PAU) is a facility within which, children with acute illnesses, injuries or other urgent referrals (from GPs, Community Nursing teams, Walk-in Centres (WICs), NHS Direct (NHSD) and Emergency Departments) can be assessed, investigated, observed and treated without recourse to inpatient areas. For example: Paediatric Short Stay (PSS), Paediatric Assessment Units (PAUs) and Paediatric Short Stay Assessment Units (PSSAU). We are looking at the PAU provision across London which takes acute admissions for a maximum period of 24hrs. This unit is separate to the paediatric day unit (although we recognise in some hospitals these may be combined). 11

12 Background Information (2 of 2) The RCPCH proposed the development of PAUs in the paediatric emergency pathway, to allow discharge for those who were improving after initial treatment (i.e. asthma, croup, gastroenteritis) or not deteriorating (i.e. fever in infant). Despite the widespread adoption of and investment in PAUs across the UK, their impact has been poorly evaluated. 12

13 London FCEs for CYP 0-18 years, , , , ,000 50,000 - <1 1-4y 5-9y 10-14y 15-18y

14 What do we know about the impact of PAUs? Ogilvie (2005). Hospital based alternatives to acute paediatric admission: a systematic review. ADC 90: studies included PAU 40% of children attending acute assessment units in paediatric departments, and over 60% of those attending acute assessment units in A&E departments, do not require inpatient admission. 1-7% returned within 72 hours of discharge Effect on inpatient admissions 10-47% reductions in inpatient admissions after opening a PAU Reduced costs due to fewer admissions

15 What do we know about the impact of PAUs? Thompson Coon et al (2012). Interventions to reduce acute paediatric hospital admissions: a systematic review. Archives of Disease in Childhood; 97(4): papers on effects of a short-stay assessment unit. Findings from each study: 77% of children admitted after presenting with acute gastroenteritis in where no PAU versus 42% in PAU 31% admitted for an overnight stay in the year prior to the opening of the PAU versus 24% in the year after i.e. reductions of ~ 23 to 45% in admission rates Perceptions Parents and staff preferred the PAU to traditional A&E

16 London FCEs for CYP 0-18 years, , , , ,000 50,000 - <1 1-4y 5-9y 10-14y 15-18y FCE PAU amenable?

17 PAU Survey of London Trusts: 14 responses thus far 12 have a PAU 1 has a PAU opening in a few weeks 1 has a Clinical Decision Unit within A&E and an Ambulatory Facility adjacent to the Paeds Ward Location Near Paed Ward Adjacent UCC Adjacent Paeds ward Adjacent A&E operating >5 years

18 Type of patients Cohorts of patients accepted age range MRI/bloods Ward Reviews Direct 'Passport' Outpatients Referral other community Direct GP referral From A&E as unclear re To 19 years To 18 years To 17 years To 16 years To 15 years

19 Service Management and Beds service management Joint Paeds Emergency Medicine Not stated beds Column1

20 Numbers seen & admitted Numbers seen per month December 15 June 15 January > <100 >50 41 to to to to 20 <=10 Numbers admitted as inpatients from PAU each month Column1 Those seeing <100 were those with 3 beds