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Archives of Disease in Childhood ; 107(Supplement 2):A346-A347, 2022.
Article in English | EMBASE | ID: covidwho-2064041


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.

Archives of Disease in Childhood ; 106(SUPPL 1):A488-A489, 2021.
Article in English | EMBASE | ID: covidwho-1495120


Background Between March 2020 and February 2021, 160 patients with acute covid infections and the associated paediatric inflammatory disorder, PIMS-TS, were transferred to paediatric intensive care units by the largest regional transport service in Europe. Local paediatric emergency departments have become attuned to the presentation of these patients, implementing early monitoring, workup and treatment in line with evolving national guidance. We have identified there has been reduction in the time taken to identify PIMS-TS, to initiate treatments and referral to PICU transport teams, potentially improving patient outcomes. The role and skillset of the PEM specialist is vital in providing early identification and management of this patient group. We make the case that point of care ultrasound scanning (POCUS) and applied PICU clinical skills make this a subset of specialists with potential to further improve PIMS-TS outcomes. Objectives This retrospective review compares two cohorts of PIMS-TS patients, the first and second covid waves, who required transport to paediatric intensive care units (PICU). The objective is to: 1. Describe any differences in presenting phenotypes of the two cohorts 2. Review timeliness of investigations and treatment interventions 3. Analyse changes in patient outcomes 4. Highlight where further improvement could be made, specifically around hypotension assessment and management in paediatric ED Methods A retrospective review was performed for all patients with suspected PIMS-TS and COVID-19 infection transferred to PICUs by the regional transport team between 1st March 2020 and 28th February 2021. A cross-reference of local hospital, CATS and PICU notes were used to obtain necessary clinical data. This service evaluation project was registered with the trust and local GDPR guidelines were followed. Results Data analysis is ongoing. The following areas will be reported on: Conclusions Data analysis is ongoing. Early findings suggest local hospitals are more familiar with the presenting features of PIMS-TS and the spectrum of conditions it has phenotypical overlap with. In the first wave there were delays in diagnosis, in the second wave there is a suggestion of potential over diagnosis - attention and caution around this is vital. Teams were vigilant around hypotension, with early use of vasoactive agents rather than large fluid resuscitation volumes. The number of ECHOs (particularly POCUS assessments) performed increased guiding decisions around transfer and vasoactive choice. Frontline PEM clinicians have an important skillset in early detection and management of PIMS-TS patients, especially those needing cardiovascular support. Applying POCUS training for clinical assessment of cardiac function and inserting peripheral arterial lines under local anaesthetic to obtain accurate BP recordings can guide prompt and appropriate treatment for patients with PIMS-TS. This has wider-reaching implications on PEM training and their evolving role within the paediatric service.