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Abstract
Aims Clinical concern had arisen at our centre that there was delayed tracing of some paediatric contacts of tuberculosis (TB) due to high clinical workload and patient non-attendance. We therefore aimed to evaluate the size of the problem and instigate interventions to improve the service.
Methods Figure 1 shows the pathway for tracing child contacts and highlights potential points of delay. We identified 23 child contacts of confirmed TB and audited their clinical notes. We determined the number of children who were traced on target, and the median times taken for children to move through the pathway. On the basis of this we implemented new guidelines with stringent time frames for the highest risk children and reaudited the service, evaluating a further 59 cases.
Summarises the characteristics of the children in the two audits
Table 2 shows the number of children who moved through the pathway on target, broken down by risk. The table demonstrates a non-significant improvement in children meeting these targets particularly in the high and medium risk groups. Patients not attending appointments (DNAs) affected 11 of 23 cases in the initial audit and 13 of 59 cases in the re-audit. Comparing audits there is no overall difference in “delay 1” (median 21 vs 22 days respectively, p = 0.71). However, after the intervention, there is a non-significant improvement in “delay 2”, children being seen more quickly by the paediatric consultant if necessary (median 22 vs 17 days, p = 0.3).
Targets for being seen and delays in achieving these
Conclusions There are no national guidelines towards timings. The interventions instigated in this service improvement project have led to a trend towards meeting stringent targets, particularly in high and medium risk children. However, reliably meeting such targets is difficult particularly when DNAs present such a significant problem. A standard letter has been developed to send to parents of high-risk non-attenders warning that referrals to social care will be made if not brought to hospital. Further work is needed to continue to improve the service offered.
Pathway through the TB service.