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Comparison of costs of acute care by children's community nursing teams
  1. H Weatherly1,
  2. S Kirk2,
  3. R G Kyle3,
  4. P Callery2
  1. 1Centre for Health Economics, University of York, York, UK
  2. 2School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
  3. 3Cancer Care Research Centre Department of Nursing and Midwifery, University of Stirling, Stirling

Abstract

Aims To explore services used by acutely ill children prior to their use of a Children's Community Nursing Team (CCNT); the costs of CCNT and other services used during the CCNT episode of care; the costs of National Health Service (NHS) services to support caring for these children at home; and the actual and potential costs to families of providing support for these children at home.

Methods Three case studies of CCNTs, including analysis of routinely collected data and a questionnaire survey completed by the parents of 698 children following CCNT care.

Results The staffing band of the nurses delivering CCNT care differed across the three case studies. A variety of services was used from the time the parent first became concerned about their child's health to the time when their child was referred to the CCNT: A&E (67% to 83%); overnight hospital admission (18% to 59%); General Practitioner (26% to 45%). On average, the CCNT visited each child two to three times over the episode of care (average visit length 15 to 18 min). During CCNT care hospital admissions ranged from 4% to 16%, A&E attendances from 4% to 25% and GP attendances from 10% to 16%. The average cost of CCNT care ranged from £63 to £76 but from £150 to £240 when all NHS services were taken into account. The lowest overall costs occurred in the CCNT, with the largest proportion of staff on higher salaries. While caseloads varied in the CCNTs, the proportion of parents describing their child's usual health as ‘good’ ranged from 72% to 78%. Assuming a working day of 7.5 h, on average, each child's carer spent around 2 days off work to care for the child while they were sick.

Conclusions In the three case studies considerable use was made of a range of health services prior to accessing CCNT. Children's illnesses imposed considerable costs on the carers. When all NHS resource use is taken into account care by CCNTs that employ nurses on higher salaries can have lower overall costs.

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