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What can we do to improve care & experience for children and not break the workforce this winter?
A thread (needed more than 3)
Please note this doesn't cover at all ongoing collateral damage to those without acute needs - these will need other solutions! https://twitter.com/MelissaAshe/status/1283830608544911360
A thread (needed more than 3)
Please note this doesn't cover at all ongoing collateral damage to those without acute needs - these will need other solutions! https://twitter.com/MelissaAshe/status/1283830608544911360
1.
A national campaign highlighting to parents & carers they successfully cared for their children during the initial phases of #COVID19
(this will appear counter-intuitive)
Minor injuries & illness can be managed safely at home
Families do make the right decisions
A national campaign highlighting to parents & carers they successfully cared for their children during the initial phases of #COVID19
(this will appear counter-intuitive)
Minor injuries & illness can be managed safely at home
Families do make the right decisions
We need to find a way of balancing this message against the fact that acute and emergency services are open.
Yes they are, and they always will be.
But the primary signal should be one of support; not of fear that they will miss serious illness in their children.
Yes they are, and they always will be.
But the primary signal should be one of support; not of fear that they will miss serious illness in their children.
The potential for delayed presentations is very real.
However the risks can, and have been, mitigated: https://twitter.com/Damian_Roland/status/1276801633318367234
It's not an easy media message, but if we shy away from it we risk exacerbating the very problem we're trying to avoid: overcrowded departments
However the risks can, and have been, mitigated: https://twitter.com/Damian_Roland/status/1276801633318367234
It's not an easy media message, but if we shy away from it we risk exacerbating the very problem we're trying to avoid: overcrowded departments
2.
Clear guidance on when redirection to other units may be needed should be available because..
..highly likely if we're not able to provide enhanced pre-hospital advice & hospital bed base isn't expanded, Children's Emergency Departments will become stagnant ponds of illness
Clear guidance on when redirection to other units may be needed should be available because..
..highly likely if we're not able to provide enhanced pre-hospital advice & hospital bed base isn't expanded, Children's Emergency Departments will become stagnant ponds of illness
While children are least likely to catch and suffer from #COVID19 it makes no sense to bring their parents together in close quarters for prolonged periods of time.
This will increase risk to families and staff.
Therefore thresholds may be needed to redirect to other units
This will increase risk to families and staff.
Therefore thresholds may be needed to redirect to other units
3.
All options (in multiple languages) need to be available to parents and carers
111 is being expanded; this is a great step.
Primary care also needs access to expert advice. Already national guidance that GPs should be able to phone a paediatricians directly about cases.
All options (in multiple languages) need to be available to parents and carers
111 is being expanded; this is a great step.
Primary care also needs access to expert advice. Already national guidance that GPs should be able to phone a paediatricians directly about cases.
This needs to be a standard of care in all regions and localities and not a recommendation.
And will require additional resource to enable more staff to take calls (and also provide video facilities where appropriate)
And will require additional resource to enable more staff to take calls (and also provide video facilities where appropriate)
4.
Should be unacceptable for a child to present to ED
i) for routine bloods tests
ii) because on call paediatrician wasn't available by phone
iii) because referrer wasn't sure what do to
If occurring should require joint-response by primary & secondary care to create solution
Should be unacceptable for a child to present to ED
i) for routine bloods tests
ii) because on call paediatrician wasn't available by phone
iii) because referrer wasn't sure what do to
If occurring should require joint-response by primary & secondary care to create solution
5.
Probably too late but should be pump priming elective paediatric surgery now to undertake as much operating capacity as possible to release periods in the winter
Probably too late but should be pump priming elective paediatric surgery now to undertake as much operating capacity as possible to release periods in the winter
6.
Hospitals should look at staffing models for sedative procedures which don't require staff on the acute floor.
Possible to undertake ketamine lists to stop overnight admissions for theatre (and therefore free up beds) without using Emergency Nursing staff.
Hospitals should look at staffing models for sedative procedures which don't require staff on the acute floor.
Possible to undertake ketamine lists to stop overnight admissions for theatre (and therefore free up beds) without using Emergency Nursing staff.
7.
Daily +/- Weekly Children's Gold Command meetings to involve commissioners and primary care representatives - need to ensure all parts of the system are aware of system bottle necks: Pre-, Within and After the Emergency Department/Assessment Unit.
Daily +/- Weekly Children's Gold Command meetings to involve commissioners and primary care representatives - need to ensure all parts of the system are aware of system bottle necks: Pre-, Within and After the Emergency Department/Assessment Unit.
8.
....and probably above all: Share good practice!
http://bit.ly/proformashare
https://twitter.com/Damian_Roland/status/1278980437164077057
/endthread
....and probably above all: Share good practice!
http://bit.ly/proformashare
https://twitter.com/Damian_Roland/status/1278980437164077057
/endthread
