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Can a paediatric nurse-led community service reduce acute hospital admissions?
  1. L M Langton1,
  2. A Elias-Jones2,
  3. L Vernon1
  1. 1Children's Rapid Assessment and Follow-up Team, Children's Community Health Service, NHS Leicester City, Leicester, UK
  2. 2Paediatric Medical Service, Children's Community Health service, NHS Leicester City, Leicester, UK

Abstract

Aims To introduce a community based nurse-led service with the aim of reducing unscheduled paediatric admissions into hospital, which can safely be managed in the community. Locally, 56% of unscheduled acute admissions into hospital are made by General practitioners (GP). Of these 46% are discharged home within 6 h.

Methods The service was run as a 12 month pilot project. Staffed by children's nurses with advanced minor illness management skills, the service provided follow-up visits in the home for children with mild to moderate episodes of minor illness. The target group were children who would otherwise have been admitted to hospital by the GP, Emergency Department or Walk-in-centre. A robust referral system ensured the children were safely discharged home for follow-up. A cluster of GP's, paediatric ED specialists and a consultant paediatrician had input in development of the service.

Results The pilot project received 586 referrals. 195 referrals (33%) identified as admission avoidance. Others were referred by clinicians identifying a need for nursing support after discharge. 22 referrals (4%) were returned to hospital for medical review or admission due to change or deterioration in condition. There were no deaths or serious incidents. User satisfaction was high as reported through a service review and evaluation process.

Cost analysis Cost to run the service, £160 564. Average cost per referral into the service, £274. ED admission costs £60, hospital admission, £260 on first contact, rising to £700 for a stay >4 h. Total saving £113 340, assuming that the majority of admissions into hospital incur the higher fee. The lesser cost of ED admission is accounted for.

Conclusions The cost of delivering the service was greater than the savings realised. However, some savings may not have been counted as it is not possible to identify where parents would have sought medical advice had this service not been available. Some over and under estimation of savings may have arisen for differing lengths of hospital stay. Attracting referrals based on admission avoidance would increase service productivity. Families valued the service highly; felt supported, reassured and recognised the significance of avoiding hospital admission.

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