Multi-method evaluation of a paediatric ambulatory care unit (PACU): impact on families and staff
- 1Imperial College, London and River Island Paediatric and Child Health Academic Centre, Northwick Park Hospital Campus, Harrow, Middlesex, UK
- 2North West London Hospitals NHS Trust, Northwick Park Hospital, Harrow, Middlesex, UK
- 3School of Health Sciences and Social Care, Brunel University, Uxbridge, Middlesex, UK
- 4Great 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
- Accepted 15 February 2008
- Published Online First 12 March 2008
Abstract
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.
Footnotes
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All authors are the main contributors.
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Funding: Supported by NHS R&D Support Funding (Department of Health). A Knowledge Transfer Partnership (KTP) grant (Department of Health) was secured for a wider evaluation of redesigned services at NWLH Trust (led by JG) and was used, in part, to support SP’s involvement in this related project. The research team were independent of funders in terms of protocol development, analysis of results and drafting of this article.
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Competing interests: The authors wish to clarify that they work, or have worked, for the North West London Hospitals NHS Trust where the research took place. FI is a full-time consultant who worked in PACU at the time of the study. JG and SP are independent researchers funded by the Trust/DoH. As in any service evaluation, the results of the study may be used to inform future implementation of the service. The team maintain an independent role in this evaluation.
