Background In Northwest London, CQUIN (Commissioning for quality and Innovation) standards on consultant assessments of paediatric admissions replaced previous RCPCH standards. The CQUIN requirement was that 75% (year 1) and 90% (year 2) of paediatric admissions to be assessed by a consultant within 12 h between Monday and Friday (50% for weekends). RCPCH standards deemed that consultants should review admissions within 24 h.
Aim To audit
Compliance of above CQUIN standards before and after implementation of in a large district general hospital and
Whether this review alters patient management.
Method Retrospective case note review of 50 random general paediatric admissions in May 2012 followed by a similar 4week prospective review ending in January 2013. CQUIN standards were implemented in July- August 2012 with an awareness campaign amongst the attending medical team. Data was collected on diagnosis, senior review details and whether consultant review altered clinical management.
Results A total of 98 paediatric admissions were studied (49 in each period – 2 cases excluded for wrong speciality). Prior to introduction of CQUIN standards, only 16.3% and 51% of admissions to the wards were reviewed by a consultant within 12 and 24 h respectively. In the post-CQUIN period, the figures were significantly higher at 44.9 and 96% respectively. However, 12 h consultant review changed management only in 18.2% of the cases compared to 75% in the pre-CQUIN period. There was an increased tendency for children with less morbidity (eg: Viral induced wheeze) to get a 12 h consultant review in the post-CQUIN period.
Conclusion This audit demonstrates that with the introduction of CQUIN standards, there was a significant improvement (2–3 fold) in consultant contact for paediatric inpatients, with no injection of additional resources. However, the 12 h reviews seem to alter management in a smaller proportion of cases in the post CQUIN period, possibly implying that consultants are reviewing less sick children. Whilst this CQUIN standard will improve consultant contact and patient care it raises the question whether resources and expertise are being appropriately deployed in already overburdened paediatric units.
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