Original articles

Multi-method evaluation of a paediatric ambulatory care unit (PACU): impact on families and staff

M Blair¹, J Gore², F Isaza², S Pajak³, A Malhotra², S Islam², T V Vigneswaran², P Lachman⁴

¹ Imperial College, London and River Island Paediatric and Child Health Academic Centre, Northwick Park Hospital Campus, Harrow, Middlesex, UK
² North West London Hospitals NHS Trust, Northwick Park Hospital, Harrow, Middlesex, UK
³ School of Health Sciences and Social Care, Brunel University, Uxbridge, Middlesex, UK
⁴ Great Ormond Street Hospital for Children NHS Trust, London, UK

Dr Mitch Blair, North West London Hospitals NHS Trust, River Island Paediatric and Child Health Academic Centre, Northwick Park Hospital, Harrow, Middlesex HA13UJ, UK; m.blair{at}imperial.ac.uk

Aim: To assess the impact of a purpose-built, short stay paediatric ambulatory care unit (PACU) on the patient journey and perceptions of parents, staff and referrers.

Methods: Multi-method evaluation, including a parent survey (n = 104), patient journey mapping (n = 10), staff interviews (n = 10), a referrer survey (n = 16), routine activity analysis, and a comparison with the A&E service (A&E parent survey: n = 41).

Results: Almost all parents attending PACU (94%) were satisfied with the service and significantly more likely to feel "very" satisfied than parents attending A&E (PACU: 51%, A&E: 31%; p = 0.03). Further, over three quarters (77%) of PACU parents preferred the new model to traditional A&E services. They reported receiving sufficient information (93%), reduced anxiety (55% anxious before service, 13% anxious after; p<0.001), "quick" waiting times (median: 35 min), and enhanced confidence (87%) and understanding (89%) in dealing with their ill child. The number of stages in the patient journey was reduced from six ("traditional" A&E pathway) to four (PACU pathway). Staff and referrers reported this was a "superior" model to A&E, but that improvements were required around appropriate referrals and the need for more multi-disciplinary protocols and liaison.

Conclusion: Our study suggests that the PACU model is perceived to be an effective alternative to standard A&E services for the assessment and early management of acutely ill children and their families attending a hospital. It is highly valued by users, staff and referrers and enhances the patient journey. Lessons learnt include the need to enhance multi-disciplinary processes and clarify the role of this form of acute care provision in the wider healthcare system.

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eLetters:

Read all eLetters

The PACU model is complimentary to Paediatric emergency but is not an Alternative.

Giles E Haythornthwaite, et al.

ADC Online, 22 Apr 2008 [Full text]

Re: The PACU model is complimentary to Paediatric emergency but is not an Alternative.

Mitch E Blair, et al.

ADC Online, 25 Jul 2008 [Full text]