Aim To implement an effective pathway to improve the central line service offered by our hospital – a service improvement project led by a Paediatric and Anaesthetic trainee.

Background Central lines (CI) are required for a variety of paediatric patients and are referred from almost every department in our hospital; and from other hospitals within our region.

An recent adverse incident lead to suboptimal care for a child and illustrated major inefficiencies in our referral system. This led us to review the process of central line placement at our centre – where currently no formal pathway exists.

Methods Firstly we performed a retrospective audit over a year to ascertain our current workload (1^st May 2012 and 31^st May 2013.) Data was collected from coding regarding insertion of CI.

Secondly a multidisciplinary team was formed of the individual departments involved in the placement of CI. We involved senior staff who could enable and implement the reforms necessary.

Results A total of 118 CI lines were inserted. In 70% (83) it was the primary (only) procedure of these 73% (61) were medical 10% (8) were trauma and orthopaedics 6% (5) were surgical 5% (4) were respiratory 2% (2) were oncology 2% (2) ENT and 1% (1) for cardiology and 30% (35) as the non-primary procedure.

Implementation This data has been used to bring forward a costed business case for a dedicated central line service. This has involved

1. A Scoping exercise for all equipment and resources requirements

2. Establishing the training requirements needed for the team placing CI’s

3. Liaison with the relevant departments to establish their requirements and to create a communications network.

4. Immediate instigation of a pilot pathway in consultation with managers and our multidisciplinary team. To improve the referral pathway, efficiency and management of the patient. Also documentation and care of central lines post insertion.

Conclusion This piece of work shows how trainees can influence the systems they work within leading to real change.

It demonstrates how communication and collaboration across disciplines can improve not only the patient care, but improve efficiency and reduce cost.