Lister hospital children day services quality improvement project

ABSTRACT

Aims• Initially to review the use of the Children’s Day Services at the Lister Hospital1. Reviewing the first of a three-part quality improvement project to review and improve the booking system for Children’s Day Services• To compare the expected demands of the day services unit with daily realities in services provided.• To assess how this interplays with staffing levels and safe, appropriate usage.• Eventually, to provide an overview of what services are required for the local population and to assess what changes might be required to deliver this safely.• Finally, to review changes implemented to improve day services especially the use of the booking system.Methods• Quantitative data1. 90 days of appointment data was reviewed retrospectively between April-June 2021. A total of 842 appointments were reviewed. This was categorised into type of day service appointment e.g. blood test, jaundice clinic, allergy etc.2. Using the data from a patient and staff survey and previous phlebotomy audit, completed by the Children’s day services team.• Qualitative data 2 weeks’ worth of qualitative data was collected. This included a written account of all informal or verbal requests including additional ‘walk-in’ patients. The qualitative data also included written accounts of staff that reflected on patient safety.ResultsOver the data collection period, blood tests accounted for 41.6% of workload, despite only 12.5% of appointments being for phlebotomy. This was reached largely through the use of designated ‘ward attender’ slots for blood tests. 20.2% of day service appointments were used to provide a prolonged jaundice clinic, which is a foundation doctor led clinic. An average of 9.3% of day services consisted of allergy clinic, while registrar reviews were 9.3% of encounters.Quantitative results overall showed a disproportionate and inappropriate number of appointments booked as blood tests, and more jaundice clinic slots than required.The qualitative data displayed a broad range of scenarios varying in complexity. Some showed foundation doctors being required to oversee difficult procedures alongside running clinic. Other scenarios included poor referrals with missing or inadequate information with demands on day services that were inappropriate and potentially unsafe.ConclusionThe day service has changed over the COVID pandemic and, with that, the demands on its staff have also changed. One key finding is that there is a high phlebotomy service demand which is currently disproportionate to expectations. The demand on prolonged jaundice clinic is lower than expected, and there is huge variety between the complexity of tasks that are indistinguishable in the current booking system. There may be opportunities to outsource phlebotomy to better use resources, while staffing should better match real demands. Patient booking must find a balance between flexibility and rigidity to ensure an efficient and safe system. Lastly, the day services unit is a bridge between the hospital service and community paediatrics and could be utilised better with the knowledge this review has shown. The next stage will be to review the changes made to the service to complete the cycle of the quality improvement project.