In the original audit (1998–2001) medical, nursing, social and resource issues contributing to long stay paediatric admissions (>100 days) were identified. 11 children were found with stays in excess of 100 days (4505 bed days) with an estimated cost of £1.5 million. It was also shown that, over time, social and resource factors became the predominant reasons preventing children’s discharge, rather than medical or nursing issues.
As a result our Trust developed a services package aimed at facilitating early discharge and maintaining home placements for children with complex needs, including a Transitional Care Team, which provides care within the hospital based Transitional Care Unit and community settings. Additionally, there is a Community Paediatric Nursing Team who facilitate care packages, respite and competency based training for those involved in the children’s care. Furthermore, there is a dedicated community paediatrician with expertise in palliative care.
We have repeated the audit 10 years later. Only 5 children stayed over 100 days resulting in 625 bed days (mean 125). This was an 86.1% reduction in bed days for patients staying greater than 100 days. Case note review suggests that in 80% (4/5) of these cases the primary reason for prolonged hospitalisation was the child’s intensive medical and nursing needs. In addition the 4 children, for whom service involvement documentation was available, had active involvement from our new services.
We believe this audit confirms our impression that development of expert community based care has significantly contributed to shortening stays for our most complex and vulnerable children.