We evaluated the quality of looked after children’s assessments by mapping the patient journey. Looked after children work is split across two different providers in our locality with our trust completing initial health assessments (IHA) and review health assessments (RHA) completed by another trust. We wanted to identify areas for improvement in joined up working to develop a truly patient centred service, crucial in this vulnerable population.
We undertook two separate audits. The first assessed quality of information gathered at initial health assessment against payment by result standards. We used data from CHIMAT (National Child and Maternal Health Intelligence Network) to understand the specific health needs of the local population and compare to our audit population. The second audit focused on whether health recommendations made at IHA were completed by RHA.
For the first audit, a sample of 70 IHA was assessed. The assessments were of a high standard. Every child had had GP and dentist registration checked, immunisation status recorded and pre-existing health needs identified. Pre-existing physical and mental health needs were found in 50% and 25% respectively. One fifth of children older than 18 months were not registered with a dentist. One fifth were not up to date with immunisation. BMI was not recorded in the assessments despite high prevalence of obesity in the local population. For the audit we calculated BMI. Only 10% were classified obese compared with 20%–25% of the local population. From the limited parental health and lifestyle information available parental smoking was six times higher than the national average.
In the second audit, of 41 health recommendations made at IHA, 30 were completed. Those not completed included outstanding immunisation, emotional health needs and blood tests. The IHA recommendations included general advice which diluted those needs specific to the individual child.
Our recommendations included improved assessment of nutritional status and drive to improve health recommendations by making them more ‘SMART’. We identified inconsistencies in parental health and lifestyle information sharing.
We shared all the findings with the other providers. Agreement was reached for more cohesive streamlined working across agencies.
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