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Abstract
Background The waiting list for review appointments in our Community Paediatric clinics is getting longer. We get frequent calls from parents and other professionals regarding delayed appointments. This audit was undertaken to attempt to change the mind-set of clinicians about offering review appointments “just in case”.1
Aims To identify the main reasons for offering follow-up appointments and to explore whether children could be reviewed by methods other than ‘face to face appointments’. We also looked at whether some children could be reviewed by other health professionals.
Methods The audit was conducted prospectively on all patients seen by Community Paediatricians from 1st May to 31ST May 2012. A form (table 1) was devised and agreed at the team meeting to be completed on all children who were offered a further follow-up appointment.
Results In total 305 forms were completed. The main reasons for follow up were to monitor developmental progress, to review children with complex special needs and medication review. 16/305 was offered further appointment on parental request. For 247/305 (81%) children, continuing with ‘Face to face’ review in clinic was the preferred option. For 44/305 (14%), Clinicians felt the children could be reviewed in an alternative way. In this group, for 34/44 children the preferred option was by another trained professional and for 10/44, by telephone review. It was identified Team around Child meetings was not a suitable option to review children.
Most children still need to be seen at ‘face to face’ clinic review. However in 14% (1 in 7) of children, alternative methods to review children can a preferred option. This can offer opportunity to increase capacity without adversely affecting quality of care.2
Specialist Health Visitors, Nursery Nurses, and Tier 2 Primary Mental Health Workers were identified; as possible professionals who can be trained to review children. Following the audit it has been planned to develop a system to record a specific reason why Clinicians wish to offer follow-up appointments and to develop a pathway to identify children who can be seen by other professionals with appropriate training. A monthly telephone review clinic will also be piloted.
References
http://www.improvement.nhs.uk/heart/sustainability/outpatients/one_stop.html accessed on 27/07/2012
I Ahmed-Jushuf, V Griffiths and Six Sigma study group. Reducing follow-ups: an opportunity to increase the capacity of genitourinary medicine services across the UK. Int J STD AIDS 1 May 2007 vol. 18 no. 5 305–307.