Lessons from the COVID-19 pandemic in paediatric post-discharge care.

The COVID-19 pandemic dictated rapid reform in outpatient paediatric services. To reduce ward footfall and its associated infection risk, a trainee-led outpatient clinic was established with the aim to provide children with continuity of care following discharge from hospital. The service was created as a safe alternative to the long-standing practice of ward attenders while reducing mounting pressures on appointments at consultant-led clinics. Several issues arose in its implementation. A retrospective analysis with insights from service users found significant communication issues at various stages in referral, booking and follow-up management. This project aimed to reduce clinic non-attendance rates and ensure timely outpatient review with effective communication to all parties.Quality improvement methods allowed the problem to be understood and defined. Through consultation with service users in the start-up phase of the project, four key criteria were determined as essential for improving communication: indication, lead consultant, patient attendance and outcome letter provision. The project aimed to achieve 100% compliance across the four criteria during the 6-month project period. A baseline measure was established and measurements collected while five interventions were tested using plan-do-study-act test cycles.Following the small-scale tests, the run chart illustrated process improvement leading to meaningful change in outcome at both patient and service level. During the project, performance increased from a baseline median of one to a minimum of three out of four criteria being met for every patient. Several patients and families had a change in management as a direct result of their timely review and communication of clinic outcomes. These interventions resulted in a 50% reduction in the clinic's did not attend rate.The initial pandemic response to facilitate post-discharge care for children and young people led to frustrations surrounding communication breakdown among service users. Targeted interventions led to the development of a safer, more efficient service. Ongoing feedback continues to guide strategies for change with future work in service development focusing on capturing patient experience and improving patient-centred outcomes.

Parents' perspectives of anorexia nervosa treatment in adolescents: a systematic review and metasynthesis of qualitative data.

BACKGROUND: Studies have established the central role of the family in the recognition, treatment, and recovery of anorexia nervosa. The objective of this study was to review, synthesize, and critically appraise the literature on parents' views on the treatment and recovery process of anorexia nervosa in their adolescent child. METHOD: A systematic search of Medline, PsychINFO, CINHAL, EMBASE, Cochrane library, and SSCI was conducted for qualitative studies published regarding parents' views about the treatment of anorexia nervosa. The quality of articles was assessed using the critical appraisal skills program (CASP) and findings were analysed using thematic synthesis. RESULTS: A total of 25 studies from nine countries reporting the views of 357 parents met the inclusion criteria. Four major themes were developed from the analysis: understanding the child and the disease, experience of services and treatment modalities, the role of professionals, and the experience of recovery. CONCLUSION: Parents report struggles with delays in finding help, judgmental attitudes of professionals, and uncertainty about the future. Recognition of the challenges faced by parents and families empowers clinicians to build stronger therapeutic relationships essential for long-term recovery from anorexia nervosa.

Interventions for adolescents with anorexia nervosa often focus on families. Although prior systematic reviews have incorporated adolescents' perspectives on their treatment for anorexia nervosa, none have previously reviewed parents' perspectives on their adolescents' treatment. We conducted a systematic review and metasynthesis of qualitative data capturing parents' perspectives of anorexia nervosa treatment in adolescents. Four themes emerged from the analysis: understanding the child and the disease, experience of services and treatment modalities, the role of professionals, and the experience of recovery. Parents report struggles with delays in finding help, judgmental attitudes of professionals, and uncertainty about the future. Recognition of the challenges faced by parents and families empowers clinicians to build stronger therapeutic relationships essential for long-term recovery from anorexia nervosa.