Identifying and prioritising future interventions with stakeholders to improve paediatric urgent care pathways in Scotland, UK: a mixed-methods study

Emma King; Emma France; Cari Malcolm; Sachin Kumar; Smita Dick; Richard G Kyle; Philip Wilson; Lorna Aucott; Steve Turner; Pat Hoddinott

doi:10.1136/bmjopen-2023-074141

Identifying and prioritising future interventions with stakeholders to improve paediatric urgent care pathways in Scotland, UK: a mixed-methods study

Emma King^* (Corresponding Author), Emma France, Cari Malcolm, Sachin Kumar, Smita Dick, Richard G Kyle, Philip Wilson, Lorna Aucott, Steve Turner, Pat Hoddinott

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

1 Downloads (Pure)

Abstract

Objectives
To identify and prioritise interventions, from the perspectives of parents and health professionals, which may be alternatives to current unscheduled paediatric urgent care pathways.

Design
FLAMINGO (FLow of AdMissions in chIldren and youNG peOple) is a sequential mixed-methods study, with public and patient involvement (PPI) throughout. Data linkage for urgent admissions and three referral sources: emergency department, out of hours service and general practice, was followed by qualitative interviews with parents and professionals. Findings were presented and discussed at a stakeholder intervention prioritisation event.

Participants
Quantitative data: children with urgent medical admission to hospital from 2015 to 2017. Qualitative interviews: parents and health professionals with experiences of urgent short stay hospital admissions of children. PPI engagement was conducted with nine parent–toddler groups and a university-based PPI advisory group. Stakeholder event: parents, health professionals and representatives from Scottish Government, academia, charities and PPI attended.

Results
Data for 171 039 admissions which included 92 229 short stay admissions were analysed and 48 health professionals and 21 parents were interviewed. The stakeholder event included 7 parents, 12 health professionals and 28 other stakeholders. Analysis and synthesis of all data identified seven interventions which were prioritised at the stakeholder event: (1) addressing gaps in acute paediatric skills of health professionals working in community settings; (2) assessment and observation of acutely unwell children in community settings; (3) creation of holistic children’s ‘hubs’; (4) adoption of ‘hospital at home’ models; and three specialised care pathways for subgroups of children; (5) convulsions; (6) being aged <2 years old; and (7) wheeze/bronchiolitis. Stakeholders prioritised interventions 1, 2 and 3; these could be combined into a whole population intervention. Barriers to progressing these include resources, staffing and rurality.

Conclusions
Health professionals and families want future interventions that are patient-centred, community-based and aligned to outcomes that matter to them.

Original language	English
Article number	e074141
Number of pages	12
Journal	BMJ Open
Volume	13
Issue number	10
Early online date	12 Oct 2023
DOIs	https://doi.org/10.1136/bmjopen-2023-074141
Publication status	Published - 12 Oct 2023

Bibliographical note

Acknowledgments
Amy Woodhouse of Children in Scotland registered charity critically reviewed and commented on drafts of this manuscript. We are grateful for Dave Kelly at Albasoft for providing primary care data. We are grateful to Rebecca Fairnie at Electronic Data Research and Innovation Service for managing our access to all data. The authors would like to extend our thanks to the parents and health professionals who participated in this study, and to the stakeholders who participated in both public and patient involvement activities and the engagement and prioritisation event.
Funding :This work was supported by the Chief Scientist Office of the Scottish Government, grant number HIPS/18/09

Keywords

Urgent care
paediatrics
Patient and Public Involvement
short stay admission
qualitative
mixed methods

Access to Document

10.1136/bmjopen-2023-074141Licence: CC BY

King_etal_BMJO_Indentifying_And_Prioritising_VoR
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Final published version, 11.7 MBLicence: CC BY

Cite this

@article{f7500a5113a84e06a46afd3de40d9601,

title = "Identifying and prioritising future interventions with stakeholders to improve paediatric urgent care pathways in Scotland, UK: a mixed-methods study",

abstract = "Objectives To identify and prioritise interventions, from the perspectives of parents and health professionals, which may be alternatives to current unscheduled paediatric urgent care pathways.Design FLAMINGO (FLow of AdMissions in chIldren and youNG peOple) is a sequential mixed-methods study, with public and patient involvement (PPI) throughout. Data linkage for urgent admissions and three referral sources: emergency department, out of hours service and general practice, was followed by qualitative interviews with parents and professionals. Findings were presented and discussed at a stakeholder intervention prioritisation event.Participants Quantitative data: children with urgent medical admission to hospital from 2015 to 2017. Qualitative interviews: parents and health professionals with experiences of urgent short stay hospital admissions of children. PPI engagement was conducted with nine parent–toddler groups and a university-based PPI advisory group. Stakeholder event: parents, health professionals and representatives from Scottish Government, academia, charities and PPI attended.Results Data for 171 039 admissions which included 92 229 short stay admissions were analysed and 48 health professionals and 21 parents were interviewed. The stakeholder event included 7 parents, 12 health professionals and 28 other stakeholders. Analysis and synthesis of all data identified seven interventions which were prioritised at the stakeholder event: (1) addressing gaps in acute paediatric skills of health professionals working in community settings; (2) assessment and observation of acutely unwell children in community settings; (3) creation of holistic children{\textquoteright}s {\textquoteleft}hubs{\textquoteright}; (4) adoption of {\textquoteleft}hospital at home{\textquoteright} models; and three specialised care pathways for subgroups of children; (5) convulsions; (6) being aged <2 years old; and (7) wheeze/bronchiolitis. Stakeholders prioritised interventions 1, 2 and 3; these could be combined into a whole population intervention. Barriers to progressing these include resources, staffing and rurality.Conclusions Health professionals and families want future interventions that are patient-centred, community-based and aligned to outcomes that matter to them.",

keywords = "Urgent care, paediatrics, Patient and Public Involvement, short stay admission, qualitative, mixed methods",

author = "Emma King and Emma France and Cari Malcolm and Sachin Kumar and Smita Dick and Kyle, {Richard G} and Philip Wilson and Lorna Aucott and Steve Turner and Pat Hoddinott",

note = "Acknowledgments Amy Woodhouse of Children in Scotland registered charity critically reviewed and commented on drafts of this manuscript. We are grateful for Dave Kelly at Albasoft for providing primary care data. We are grateful to Rebecca Fairnie at Electronic Data Research and Innovation Service for managing our access to all data. The authors would like to extend our thanks to the parents and health professionals who participated in this study, and to the stakeholders who participated in both public and patient involvement activities and the engagement and prioritisation event. Funding :This work was supported by the Chief Scientist Office of the Scottish Government, grant number HIPS/18/09",

year = "2023",

month = oct,

day = "12",

doi = "10.1136/bmjopen-2023-074141",

language = "English",

volume = "13",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "10",

}

TY - JOUR

T1 - Identifying and prioritising future interventions with stakeholders to improve paediatric urgent care pathways in Scotland, UK

T2 - a mixed-methods study

AU - King, Emma

AU - France, Emma

AU - Malcolm, Cari

AU - Kumar, Sachin

AU - Dick, Smita

AU - Kyle, Richard G

AU - Wilson, Philip

AU - Aucott, Lorna

AU - Turner, Steve

AU - Hoddinott, Pat

N1 - Acknowledgments Amy Woodhouse of Children in Scotland registered charity critically reviewed and commented on drafts of this manuscript. We are grateful for Dave Kelly at Albasoft for providing primary care data. We are grateful to Rebecca Fairnie at Electronic Data Research and Innovation Service for managing our access to all data. The authors would like to extend our thanks to the parents and health professionals who participated in this study, and to the stakeholders who participated in both public and patient involvement activities and the engagement and prioritisation event. Funding :This work was supported by the Chief Scientist Office of the Scottish Government, grant number HIPS/18/09

PY - 2023/10/12

Y1 - 2023/10/12

N2 - Objectives To identify and prioritise interventions, from the perspectives of parents and health professionals, which may be alternatives to current unscheduled paediatric urgent care pathways.Design FLAMINGO (FLow of AdMissions in chIldren and youNG peOple) is a sequential mixed-methods study, with public and patient involvement (PPI) throughout. Data linkage for urgent admissions and three referral sources: emergency department, out of hours service and general practice, was followed by qualitative interviews with parents and professionals. Findings were presented and discussed at a stakeholder intervention prioritisation event.Participants Quantitative data: children with urgent medical admission to hospital from 2015 to 2017. Qualitative interviews: parents and health professionals with experiences of urgent short stay hospital admissions of children. PPI engagement was conducted with nine parent–toddler groups and a university-based PPI advisory group. Stakeholder event: parents, health professionals and representatives from Scottish Government, academia, charities and PPI attended.Results Data for 171 039 admissions which included 92 229 short stay admissions were analysed and 48 health professionals and 21 parents were interviewed. The stakeholder event included 7 parents, 12 health professionals and 28 other stakeholders. Analysis and synthesis of all data identified seven interventions which were prioritised at the stakeholder event: (1) addressing gaps in acute paediatric skills of health professionals working in community settings; (2) assessment and observation of acutely unwell children in community settings; (3) creation of holistic children’s ‘hubs’; (4) adoption of ‘hospital at home’ models; and three specialised care pathways for subgroups of children; (5) convulsions; (6) being aged <2 years old; and (7) wheeze/bronchiolitis. Stakeholders prioritised interventions 1, 2 and 3; these could be combined into a whole population intervention. Barriers to progressing these include resources, staffing and rurality.Conclusions Health professionals and families want future interventions that are patient-centred, community-based and aligned to outcomes that matter to them.

AB - Objectives To identify and prioritise interventions, from the perspectives of parents and health professionals, which may be alternatives to current unscheduled paediatric urgent care pathways.Design FLAMINGO (FLow of AdMissions in chIldren and youNG peOple) is a sequential mixed-methods study, with public and patient involvement (PPI) throughout. Data linkage for urgent admissions and three referral sources: emergency department, out of hours service and general practice, was followed by qualitative interviews with parents and professionals. Findings were presented and discussed at a stakeholder intervention prioritisation event.Participants Quantitative data: children with urgent medical admission to hospital from 2015 to 2017. Qualitative interviews: parents and health professionals with experiences of urgent short stay hospital admissions of children. PPI engagement was conducted with nine parent–toddler groups and a university-based PPI advisory group. Stakeholder event: parents, health professionals and representatives from Scottish Government, academia, charities and PPI attended.Results Data for 171 039 admissions which included 92 229 short stay admissions were analysed and 48 health professionals and 21 parents were interviewed. The stakeholder event included 7 parents, 12 health professionals and 28 other stakeholders. Analysis and synthesis of all data identified seven interventions which were prioritised at the stakeholder event: (1) addressing gaps in acute paediatric skills of health professionals working in community settings; (2) assessment and observation of acutely unwell children in community settings; (3) creation of holistic children’s ‘hubs’; (4) adoption of ‘hospital at home’ models; and three specialised care pathways for subgroups of children; (5) convulsions; (6) being aged <2 years old; and (7) wheeze/bronchiolitis. Stakeholders prioritised interventions 1, 2 and 3; these could be combined into a whole population intervention. Barriers to progressing these include resources, staffing and rurality.Conclusions Health professionals and families want future interventions that are patient-centred, community-based and aligned to outcomes that matter to them.

KW - Urgent care

KW - paediatrics

KW - Patient and Public Involvement

KW - short stay admission

KW - qualitative

KW - mixed methods

U2 - 10.1136/bmjopen-2023-074141

DO - 10.1136/bmjopen-2023-074141

M3 - Article

C2 - 37827745

SN - 2044-6055

VL - 13

JO - BMJ Open

JF - BMJ Open

IS - 10

M1 - e074141

ER -

Identifying and prioritising future interventions with stakeholders to improve paediatric urgent care pathways in Scotland, UK: a mixed-methods study

Abstract

Bibliographical note

Keywords

Access to Document

Fingerprint

Cite this