COAST

Children’s Outreach Assessment and Support Team (COAST), Solent NHS Trust

Started: 2008
Region: South East
Geography: Portsmouth and Southampton

Background

Facilitate early discharge from hospital
Reduce unnecessary attendances and admissions to hospital

Aims

Providing a safe service which can assess and monitor a child during an acute episode of illness in their own homes, whilst also providing support and education to the family.

Target patient groups

Acutely unwell CYP

The service model

COAST is a distinct team of experienced paediatric nurses within the CCN service who have all completed a ‘History taking and assessment’ module
2 teams (Portsmouth and Southampton)
Nurses provide assessment of a CYP during an acute episode of illness, whilst also providing support/education to family.
COAST team manage 10 HRGs (Healthcare resource groups) –

Croup
Viral induced wheeze
Asthma
Chest infection
Tonsillitis
Bronchiolitis
Febrile convulsion
Gastroenteritis
Urinary tract infection
Viral upper respiratory tract infection (URTI)

A traffic light assessment system is used to indicate the severity of illness
The COAST team complete a rapid telephone assessment using a traffic light assessment within 2 hours of referral; following this assessment a home visit may be offered and completed (same day or next day). Telephone support is maintained throughout the admission. Signs and symptoms of deteriorating condition and safety net advice will be given and reiterated.
If there are serious concerns, the family is advised to attend ED or referred to the Children’s Assessment Unit at the local hospital

Criterion for referral

The CYP must have had a ‘face-to-face’ assessment by a doctor/accredited practitioner
They must have a working diagnosis which is 1 of the 10 conditions that COAST manages
Practitioner is considering sending the child to hospital

Opening times

7 days a week
364 days a year (not Christmas day)
COAST East 8am -10pm Monday to Friday
9am -6pm Saturday, Sunday, bank holidays
COAST West 10am-8pm Monday to Friday
9.30am -5.30pm Saturday, Sunday, bank holidays

Staffing

Team Leader – Band 7
COAST nurse- Band 6
COAST nurses – Band 5
Trainee APNP – Band 5

Who can refer

GPs
Out-of-hours GPs service
Emergency department
Paediatric in-patient wards (Portsmouth City only

Who is accountable for patients

Referrers maintain medical accountability

Funding organisation

Four different commissioning groups: Portsmouth, Fareham and Gosport, South East Hampshire and Southampton CCGs.

Level of patient/family involvement

Form for feedback is sent to all families on discharge. Participate in Friends and Family Test (FFT). Revision of service work is now being co-designed.

Level of integration in the system

Exploring beginnings of vertical integration by co-locating in hospital ED department and working with specific GP practices. Service line reconfiguring for managing child health and services for populations within own multi service child & family service, beginning vertical healthy child programme and Multi Agency Teams in Portsmouth City Council.

Evaluation

Total referral incidence of nearly 10,000 CYP
There have been no clinical safety incidents
There have been no complaints
In a 6-month period, 876 CYP were referred to COAST East (297 of these would have been sent to hospital if COAST didn’t exist)
(Over these 6 months there was a theoretical saving of £49,335)

Commissioners report that there has been a ‘flattening’ of the number of referrals to hospital when compared to other CCGs without COAST

Challenges, successes, lessons learned and advice

One of the challenges for the team is being able to provide the reassurance that the CYP can be managed safely in their own home
Capturing meaningful data to evidence that COAST is making a positive difference is challenging
Engaging GPs and primary care to ensure they utilise the service appropriately has been an ongoing challenge
There are challenges when working for different CCGs e.g. they fund different things
It would be beneficial to expand/enhance the COAST model by providing partnership working with the Children’s emergency department
It would be good to continue to develop paediatric nurse practitioners within the COAST team, to work alongside primary care in support of the hospital avoidance target
It is important to develop clear and meaningful outcome measures
It is important to forge strong links with key individuals in primary and secondary care
It is important to have ‘champions’ for the service
It is crucial to recruit staff with the right skills and experience
The development of robust evidence-based protocols, and continued auditing of these has ensured safety
The continued maintenance of the assessment skills of the team has ensured safety

Contact for more information

Visit the Solent NHS Trust website for more details

Nicky Packham – Team leader – Solent NHS Trust, nicky.packham@solent.nhs.uk, 07778670594

Lois Pendlebury – Programme lead for care – Solent NHS Trust, lois.pendlebury@solent.nhs.uk

Office: 02392 219396

In: Case studies

Tagged: acutely unwell children and young people: compendium of new care models, children and young people, Out-of-hospital care

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