Rotherham’s urgent referrals clinic for children under 16 years of age
Started: 1995
Region: Rotherham
Geography: Urban
Estimated local pop. 0-18 years: 62,000
Background
To provide an immediate consultant appointment for GP and emergency department referrals for children <16 years (who are not acute emergencies but can’t wait for a routine outpatient appointment).
Aims
To see urgent GP referrals (less than 16 yrs) who are not acute emergencies but cannot wait for a clinic appointment.
Target patient groups
0-16 years
The service model
- Rapid-access clinic is located within a children’s clinic on the hospital site
- Full access to pharmacy, laboratory and imaging services
- Access to inpatient facilities if required
- 30 minute appointments
- Bookings are only made 2-working days in advance
- If no slots available, the clinic staff member re-directs the call to the on-call paediatric registrar, who can discuss alternatives (children’s assessment unit, routine clinic appointment, specialist nurses)
- The referrer is expected to fax a letter. ED clinicians tend to call as well.
- There are no triage criteria for the referral and there is no clinician responsible for this process. Waits for routine outpatient appointments are usually 4-6 weeks, but can be up to 9-12 weeks). An audit has recently shown that 82% of referrals were appropriate.
Opening times
Clinics originally ran from Tuesday to Friday (1.30pm -3.30pm) – 4 appointments/day
Due to GP feedback, Monday appointments (x4) are being offered and 3 appointments each of the rest of the days of the week.
Staffing
Consultant paediatrician, rostered to the clinic, as part of their job plan. 50% of the clinic time is given additionally as admin time)
Who can refer
- GP (mostly), ED clinicians and Consultant Paediatricians
- Referring clinician telephones a dedicated number
Who is accountable for patients?
Outpatient clinic in the main hospital premises
Resources
Outpatient clinic in the main hospital premises
Funding organisation
The Rotherham Foundation Trust
Level of patient/family involvement
None in design/production
Patient feedback and audit is carried out periodically
Level of integration in the system
Plans to set up outreach rapid access clinics
Evaluation
July 2013 – 38 case notes retrospectively reviewed
- 55% were <12 months age
- 29% were 1-5 years age
Mostly seen for medical conditions
- 79% were referred by GPs
- 8% were referred by ED
- Remaining 13% came from consultants, asthma nurses, HV
Outcomes of these 38 patients:
- 2 admitted
- 7 discharged
- 23 investigated and/or given medication
- 25 had follow-up arranged
No official evaluation/publication, but have carried out some audits.
Good feedback from GPs, but no official feedback evaluation.
It is financially beneficial for the trust because it has led to an increase in ‘new patient’ referrals (most of which are subsequently discharged)
They have a lower DNA rate (6%) than the regular outpatient clinics
Challenges, successes, lessons learned and advice
- Important to consult with stakeholders prior to developing a rapid-access clinic (GPs, commissioners, clinic staff, consultants, trainees)
- Important to identify availability of clinic rooms/scheduling
- Ensure have written set of simple guidelines for referral (including why, what, where, when, how) and would run more efficiently if there is an official triage system
- The GPs didn’t want a structured referral letter (takes too much time to complete), so they currently fax a letter to the hospital.
- Ensure the 48 hour booking rule (otherwise it isn’t a rapid access clinic)
- Monitor, evaluate, audit, implement change and repeat
- Patient satisfaction surveys provide useful feedback on the service
- A few years ago they changed the clinic to be Registrar-led, but this didn’t work so well – it needed to be led by a senior clinician i.e. Consultant
- There also used to be a Consultant hotline for GPs to discuss patients (for one hour during week Mon-Fri), but this was rarely used (?perhaps it wasn’t at a convenient time for GPs)
- The hospital also has a community nursing team to expedite discharge
- The hospital also organises regular events for GPs (with funding support from CCGs) in which they have protected-time teaching. In these clinical scenarios are discussed.
- Many referrals are due to parental anxiety
Contact for more information
Dr Sanjay Suri, Paediatric Consultant (The service was set up by his predecessors; He also chairs a local ‘Care closer to Home’ steering group for multiple stakeholders since 2012)
01709424521
In: Case studies
Tagged: acutely unwell children and young people: compendium of new care models, children and young people, Out-of-hospital care
« Back to Acutely unwell children and young people: compendium of new care models