In our area referrals about developmental concerns can be made by any professional (health service and other) and traditionally went initially to a paediatrician.
This pilot project was undertaken to relieve pressures on a service that had become overloaded following reduced paediatrician numbers and increased referrals from widely ranging sources.
Following triage, selected referrals of children under 3 were directed to appropriately trained physiotherapists for an initial screen using a validated assessment tool (Bayley Scale for Infant and Toddler). Children were then directed on to the most suitable service.
25 referrals were received over 12 weeks in the summer of 2013. 21 children attended a screening appointment. All were discussed with a consultant paediatrician after the appointment.
Outcomes were as follows:
6 children referred on to Single Patient Pathway Panel (multiagency complex needs panel).
5 to physiotherapy.
4 back to referring SALT as no additional needs were demonstrated
1 to OT
7 were offered an appointment in a Developmental Paediatric clinic for review in 4–6 months’ time
1 discharged back to GP
None were referred to complex Neuro-disability service.
Results Each child was referred to the most appropriate intervention service within 2–4 weeks of receipt of the original referral. Children going on to medical follow up appointments had already had a comprehensive assessment of their developmental status, which allowed for stramlined paediatric appointments with a focus on medical history taking, examination and targeted investigations. Parents expressed satisfaction that they had validated evidence of their child’s needs. Other services received referrals in a more timely manner than previously.
By freeing up doctor time, this approach is potentially more cost effective than the traditional arrangement and enhances patient care.
However it is important to ascertain whether there is any evidence that not seeing a paediatrician at the outset has been detrimental to any of the children. The project is ongoing but the original cohort of children is now being followed up and evaluated. By the time of the RCPCH meeting further follow up data will available. If the findings remain reassuring the project will be extended. Appropriately trained professionals from other backgrounds may join the screening team.
Other services experiencing difficulties in handling referrals may wish to consider a similar initiative, making best use of their local resources.