The Paediatric allergy service was unable to respond to increasing demand, with significant waiting times for both medical (28 weeks) and dietetic assessment (52 weeks) for infants with Cow’s milk allergy (CMA). The teams involved in the care of these infants were keen to explore a different approach in management, to provide timelier assessment of these infants.
1: To reduce waiting time for advice and assessment of the patient.
2: Improved adherence with confirmation step of diagnosis
3: Ensure dietetic outcomes met
Methods A clinic model involving group parental education material on the management of CMA was developed alongside a 1:1 assessment tool to screen for more serious allergic conditions.The clinics were based outside the hospital in community/ primary care settings, and referrals to the service were scaled up to include GP, and direct health visitor referral.Telephone followup by nurse at 6 weeks and dietitian for weaning advice were planned. During the project the clinic model was continually evaluated, (using PDSA cycles) to improve on triage/selection criteria, assessment sheet development, and follow-up protocols, along with patient satisfaction regarding accommodation and educational content.
166 new patients were triaged in first 8 months.
100% offered appointment within 8 weeks of referral.
85%–95% infants are being seen within 12 weeks of referral
Transfer rate into hospital allergy service for follow up is 30%. (6 patients/month compared with 21/month)
95% patients had completed a Milk Challenge to confirm diagnosis
100% of completed infants with CMA alone have met clinical dietetic outcomes including:
Established on appropriate milk free formula/breastfeeding
Achieving timely and appropriate milk free weaning
Resolution of symptoms
Parent/carer feedback has been uniformly highly positive, 88% parents scored the organisation, and content of the clinic as excellent, and worthwhile attending.
Team members felt reassured that the clinic was meeting patient’s needs, without compromising on quality of care.
Conclusion The project has allowed the development of a clinic model that is responsive to the needs of the parents of children with CMA. It provides a more streamlined efficient use of clinical time, and reduced patient visits to hospital clinics.
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