ABSTRACT
Aims Many paediatric emergency departments (PED) reported an unexpected increase in attendances during summer 2021;most of these children were stated to have minor illnesses and were discharged with reassurance. The primary objective of our questionnaire was to obtain parental perspective of how changes to local acute paediatric healthcare services in response to Covid-19 had impacted upon accessing care for their children. Additional objectives aimed to identify if parents were more worried about their child's health in view of the pandemic, understand parents' ideas of how children should be assessed when unwell, and explore how parents felt remote consultations could be improved. Methods A questionnaire comprised of Likert scale, multiple choice and free-text questions was developed to explore the study aiSeveral iterations of the questionnaire were test-run with parents prior to roll-out. The project was registered with the Trust's Quality Improvement team. A total of 88 families presenting to the paediatric emergency department and local urgent treatment centres completed the questionnaire between 26th October and 31st December 2021. Excluded were families for whom a translator was needed for their medical assessment. A thematic analysis was performed using NVivo, and quantitative analysis performed using PRISM statistical software. Results 68.2% of parents had sought medical advice outside of the PED prior to presentation, either in the community and/or online. 20.5% of respondents sought healthcare input from two or more sources prior to attending PED. Figure 1 outlines the responses to Likert-scale questions. Statistical analysis of the responses in relation to of age of child, number of children in the family and whether English was the family's first language was performed. Confidence of phone/video assessments and English/non-English as first language approached statistical significance (p=0.059). No other comparisons were statistically significant. Analysis of free-text responses identified key themes regarding the parental expectation of how children should be reviewed when unwell, and how parents thought remote consultations can be improved. An outline of the identified themes and a selection of responses are outlined in Figure 2. Conclusion The questionnaire identified that parents had still been able to access healthcare during the pandemic when they felt their child was unwell. Parents reported concerns of their children becoming sick with Covid-19, but still felt confident managing minor illnesses at home. The increasing volume of remote assessments in primary care was a necessary adjustment during the pandemic which is likely to be embraced as a more permanent model of service. Many parents recognised the benefit of remote consultations for non-urgent issues. However, a key theme from the questionnaire was the lack of parental confidence in remote (particularly phone) consultations;parents were more likely to still seek a face-to-face assessment in PED if they felt they couldn't communicate their child's signs and symptoms over the phone. As local networks embrace a more remote model of working to deliver some urgency and emergency care it is necessary to identify the cohorts of patients who may still attend PED, and plan how better to provide clinical reviews for them in the community.
ABSTRACT
Background More children and young people (CYP) attend Emergency departments (EDs) each year than over-65s and CYP account for up to 40% of all primary care consultations. Many CYP seen in ED or primary care are triaged through NHS 111, which is a free telephone service, wherein all calls are initially triaged by a call-handler. Where appropriate, calls are passed on to the Clinical Assessment Services (CAS) for a call-back from a clinician. During the Covid-19 pandemic, NHS 111 experienced an increase in volume of calls offered. Objectives To support NHS 111 providers in responding to paediatric calls during the Covid-19 pandemic, and to assess the feasibility of including paediatric expertise within NHS 111 CAS and its impact on service delivery. Methods In May 2020, 70 paediatric clinicians, identified via the RCPCH (or locally), were on-boarded and trained to work remotely within the CAS of six NHS 111 providers in England. Across all six NHS 111 provider sites, the volunteers worked alongside existing CAS clinicians, providing call-backs to carers of paediatric cases under 16 years old, irrespective of the presenting complaint. Data were gathered from existing NHS 111 provider systems to include immediate outcomes (dispositions) and patient/carer feedback. Contributing paediatric clinicians and NHS 111 staff were surveyed by questionnaire and/or phone call. Results 2535 paediatric cases were taken by paediatric clinicians and 137,008 paediatric cases by non-paediatric clinicians working in the six NHS 111 providers from 25th May to 4th December 2020. Disposition rates varied between the calls taken by paediatric vs non-paediatric clinicians (table 1). ∗ ∗All categories significant at p<0.01 e.g. self-care versus primary care referrals χ2 (df =1, N = 78938) = 37.95, p<0.01 Survey data from 62/70 volunteers indicated that they enjoyed working for NHS 111. NHS 111 staff surveyed (n=14) and interviewed (n=5) reported that paediatricians contributed to improving the service delivery to young patients. Feedback from carers whose calls had been taken by paediatric clinicians at one NHS 111 provider (n=60) showed higher satisfaction rates when compared with national averages for all calls (including adults and children) (92% vs 67%), with more reporting that their problem was resolved (92% vs 26%). Conclusions The data showed that enhanced paediatric support within NHS 111 CAS is likely to reduce the large volume of children advised to attend ED or primary care, while improving the families' experience. Further work will explore the longer term outcomes within the NHS, and more detailed carer feedback. In future, more integrated models of care for CYP needing urgent and emergency care services may be achieved by this means, and better access to alternative healthcare support through hospital or community-based services, such as rapid access clinics.