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Abstract
Aims The aim of this project was to initiate a new referral pathway from General Practitioner (GP) to children’s community nursing team for a select group of paediatric patients, and determine whether this reduced hospital admissions and achieved high family satisfaction.
Methods A children’s community nursing team had been established in this district general hospital to reduce non elective admissions and length of stay. This project was developed to reduce hospital admissions further by having nurses take direct referrals from GPs for a select group of paediatric illnesses where the reason for referral to paediatrics was primarily for nursing support and observation. The nurses then had to review these children at home, provide assessment and appropriate management, and discharge them (successful referrals). If these children deteriorated at home, they were then referred by the nurses to the paediatric team (unsuccessful referrals).
The referral pathway was agreed after engagement with GPs and the clinical commissioning group (CCG), and piloted in one GP practice before expansion. Appropriate training and risk governance was set up, and the clinical responsibility was retained by the GP.
Results The project was initiated in October 2014 and included one GP practice in this CCG until August 2015 when it was expanded to 19 practices. 69 children were referred from October 2014 to November 2015, of which 63 (91%) were discharged back to their GP after intervention (Figure 1 – Referrals). Thus a majority of referrals were successfully managed at home and hospital admissions were prevented. The diagnoses of referrals are listed in adjoining table (Figure 2 – Diagnoses). All of the 7 feedback forms received indicated that parents would prefer this service over a hospital admission in future and were extremely likely to recommend this service to family and friends.
Referrals
Diagnoses
Conclusion The direct referral process from GPs to children’s nurses is effective in reducing hospital admissions. It provides high user satisfaction with children being cared at home. The process has the potential to reduce financial costs for the healthcare system as children are managed outside the hospital setting.