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A stand-alone ambulatory care unit for acute paediatric services: how safe is it?
  1. V Bisht,
  2. C Powell
  1. Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, UK

Abstract

Background Delivery of healthcare services for acutely ill children in the UK has changed considerably in recent times with a trend towards minimising hospital admission and development of ambulatory care in the form of paediatric assessment or observation units. Majority of these are co-located with inpatient or emergency services and are known to provide safe and efficient alternative model of care for acutely ill children. Evidence on stand-alone units is however scarce. Such units may face many additional challenges in relation to access, quality of care and patient safety.

Aims Rapid Access Outpatient Unit (RAOU) was established in March 2005 following closure of paediatric inpatient services at a DGH and centralisation at nearby tertiary hospital. It provided support, advice and assessment for acutely ill children from 44 general practices. The aim of this study is to look at the clinical activity and outcome of the patients seen in such a stand-alone unit with emphasis on safety and feasibility of such an option.

Methods A database using Excel 2000 was designed prior to the start of the unit. Data was prospectively collected over a period of 4 years from March 2005 till July 2009. The information collected included patients age, gender, referring GP, date of contact, time of arrival, reason for referral, investigations performed, final diagnosis, procedures performed, outcome and the time of discharge. Data was analysed using Excel 2007 and SPSS16.0 version.

Results Over a period of 4 years, 7481 assessments were carried out. 82.5% were new referrals and 17.4% follow-ups. 45.6% of the patients were discharged home. There were 1.4% emergency transfers and 3.3% admissions to the inpatient unit.19.5% were discharged with follow-up in the unit itself while 15.4% were referred to out-patient department.45% of children did not require any investigations. No adverse incidents were recorded.

Conclusion With careful planning and implementation of measures ensuring quality and patient safety, a stand-alone ambulatory care unit can provide safe and efficient services. It allows the community to retain access to acute services at local level with only those needing admission required to travel long distances.

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