ABSTRACT
Background: Oral food challenge (OFC) is the gold standard for the diagnosis of food allergy. OFC are traditionally performed in hospital, as a day ward procedure, with a high medical caregiver to patient ratio. This is likely to enhance communication and patient satisfaction. Despite the high incidence of adverse reactions, families generally report a positive experience . In Sep-Oct 2020 a novel, high throughput, OFC initiative was carried out by a cross-hospital, multidisciplinary Irish paediatric allergy team. Up to 25 OFCs were performed each day at an offsite, COVID-19 stepdown facility. The unique model was designed in response to the impact of the pandemic, on provision of ambulatory allergy services. It was essential to evaluate the patient experience of this unique, alternative OFC model, compounded by COVID related distancing. Method: An anonymised survey was conducted of randomised cross-section of patients attending. The survey was completed by the primary caregiver of the child attending for the OFC. 178 survey responses were collected from a total of 474 families and included for analysis. The survey was designed to assess patient satisfaction across a number of parameters. Results: 81% of respondents were highly satisfied with ease of use of a non-hospital facility. 81% reported that the site was “child friendly”. Patient experience was scored as “excellent” 82.9% of the time with a further 12.35% reporting it as above average. Communication was effective with 89% of carers reporting good understanding of the results of the OFC. 94.7% stated that their questions were answered by the Allergy Team present. Conclusion: Our results are remarkable for enhanced patient satisfaction despite a reduced medical caregiver to patient ratio. The patient's overall satisfaction was rated overwhelmingly as “excellent” despite almost 30% of patients experiencing allergic reactions. The pandemic has forced health services to seek new ways of doing things. This data reassures, that OFC models can be changed without sacrificing patient experience.
ABSTRACT
Background: Internationally, the COVID-19 pandemic severely curtailed access to hospital facilities for those awaiting elective/semi elective procedures. For allergic children in Ireland, already waiting to 4yr for an elective oral food challenge (OFC), the restrictions signified indefinite delay. At the time of the initiative there were approx 900 children on the Chidren's Health Ireland (CHI) waiting list. In July 2020, a project was facilitated by short term (6wk) access to an empty COVID stepdown facility built, in a hotel conference centre, commandeered by the Health Service Executive Ireland (HSE). The aim was to the achieve rapid rollout of an off-site OFC service, delivering high throughput of long waiting patients, while aligning with hospital existing policies and quality standards, international allergy guidelines and national social distancing standards. Method: The working group engaged key stakeholders to rapidly develop an offsite OFC facility. Consultant Paediatric Allergists, Consultant Paediatricians, trainees and Allergy Clinical Nurse Specialists were seconded from other duties. The facility was already equipped with hospital beds, bedside monitors (BP, Pulse, Oxygen saturation) bedside oxygen. All medication and supplies had to be brought from the base hospital. Daily onsite consultant anaesthetic cover was resourced and a resuscitation room equipped. Standardised food challenge protocols were created. Access to onsite hotel chef facilitated food preparation. A risk register was established. Results: After 6wks planning, the remote centre became operational on 7/9/20, with the capacity of 27 OFC/day. 474 challenges were commenced, 465 (98%) were completed, 9(2%) were inconclusive. 135(29.03%) OFC were positive, 25(5%) causing anaphylaxis. No child required advanced airway intervention. 8 children were transferred to the base hospital. The CHI allergy waiting list was reduced by almost 60% in only 24 days. Conclusion: OFCs remain a vital tool in the care of allergic children, with their cost saving and quality of life benefits negatively affected by delay in their delivery. This project has shown it is possible to have huge impacts on a waiting list efficiently, effectively and safely with good planning and staff buy in -even in a pandemic. Adoption of new, flexible and efficient models of service delivery will be important for healthcare delivery in the post-COVID- 19 era.
ABSTRACT
Introduction To describe our experience during the COVID 19 pandemic when the acute in-patient service in CHI at Tallaght was relocated to CHI at Crumlin. Methods We describe the change management and the hospital activity across the two tertiary centres during the early pandemic (March-June 2020) and compared this to the same period in 2019. Results We compared activity during the pandemic to the same period in 2019, as the in-patient unit in Tallaght closed but day-care and OPD care continued. In CHI at Tallaght the number of day-cases and the new and review patients at ‘face to face’ OPD reduced by 76.29% (370), 67.06 % (1899) and 72.58% (2448) respectively. Similarly, in CHI at Crumlin, the admissions from ED, the day-cases, the number of new and review patients at ‘face to face’ OPD decreased by 21.74% (593), 29.14% (1442), 66.88% (2870) and 67.13% (8009) respectively. However, the number of patients managed in the virtual clinics increased significantly on both sites. All education sessions were delivered online. Conclusion With leadership, good decision making and the flexibility of clinical staff, we demonstrated how a rapid integration of services can be achieved. Whist activity levels reduced initially;new ways of working allowed us to continue to care for patients. Our shared experience was positive as we devised new team-working schedules, delivered remote education, and learned together in the midst of a crisis.