Acute assessment for children Alder Hey Children’s NHS Foundation Trust

In order to achieve the aims of the project, the team aimed to improve the following measures:

• reduce length of stay in A&E through senior review within 2 hours
• reduce unnecessary admissions
• reduce unexpected readmissions
• improve multi-disciplinary team (MDT) collaborative working
• improve staff experience.

The project reviewed the whole patient pathway from presentation at A&E, to either discharge at A&E or admission on to a ward. Areas along the pathway that were identified as needing improvement as part of the project included:

• reduction in waiting times for senior review
• reduction in waiting times for investigations
• improvement in general communication provided
• a more consistent approach to administering/monitoring pain relief
• improvement in consistency in whole patient journey from a clinical perspective.

By breaking the pathway down and reviewing/improving each section both clinically and non-clinically, the aim was to bring all departments together to ensure consistently good care. They also wanted to improve interactions with patients and families, communicating in a way they understand and makes them feel valued.

Data collected to inform the new pathway included:

• patient stories
• journey mapping
• patient shadowing
• PICKER questionnaire and 'Two Minutes of Your Time'
• standard computerised hospital records.

Specific interventions which were developed included a multi-professional abdominal pain pathway and creation of a ‘surgical decision unit’.

Who was involved?

Both the guiding council and the wider working group included multi-disciplinary representation from the whole patient journey, with the working group including staff from roles as varied as reception staff, radiographers and porters.