COVID19: QI From the Frontline 30th April, 2020
Further examples of innovation and adaptation from the paediatrics community during the first surge of COVID19 in the UK.
An RCPCH data collection platform for clinical leads to share information on the impact of COVID-19 on local child health services is currently looking at service capacity, staffing, personal protective equipment, testing availability and child health outcomes (access the platform here). Examples of innovation from the real-world data collated so far include:
- Virtual consultations:
- Outpatient video consultations via platforms Attend Anywhere or AccuRx have started with appointments also facilitated by interpreters joining remotely.
- Following telephone consultation, children who need to be examined are seen by clinicians with appropriate PPE at designated “examination clinics” with the history-taking process already completed to reduce any necessary face-to-face time.
- Online group training sessions for families with speech therapists and music therapists.
- Contact form on Trust computer systems enable real-time recording of telephone consultations that are emailed directly to the GP with a paper copy sent to the family.
- Direct GP-to-consultant advice by a Consultant Connect service or GP advice phone line is giving easier access of timely advice and reducing referral rates.
- Units are using the vCreate app for parents of babies in neonatal care.
- Trainee teaching and multi-disciplinary team meetings have continued virtually via Microsoft Teams.
- Workforce reconfiguration:
- Changes to junior and middle grade rotas with a second consultant on call at all times.
- Rotas include staff at home on standby to come in if needed with a tiered system to provide cover for any unexpected sickness or absence.
- Designated staff on junior and middle grade rotas cover maternity and SCBU to minimise the risk of infection and transmission from other paediatric inpatient areas.
- Community paediatricians without health restrictions are doing more acute work and acute paediatricians with health restrictions are doing more community work.
- Teams support Primary Care COVID-19 Assessment Hubs by telephone as well as seeing paediatric patients, with shielded staff conducting outpatient work from home.
- Outpatient nursing staff are supporting community specialist staff to visit children at home and perform investigations at home if necessary.
- Pastoral support to trainees and QI projects continue despite redeployment.
- Service development:
- Re-design of paediatric short stay, ambulatory and emergency assessment areas into designated red and green COVID-19 assessment units enable paediatric teams to see all children presenting to A&E once they are triaged. Red areas have a one-way flow of staff donning PPE at the entrance, working in the clinical area, and exiting via changing rooms with showers for decontamination.
- Access to consultant advice by email and phone for paramedics so almost all medical paediatric attendances to A&E are re-diverted to a Paediatric Assessment Unit.
- Children’s wards are divided in to “suspected COVID-19” and “clean” areas with dedicated nursing staff for each separate area.
- School nurses and hospital teams are keeping in contact with complex or high-risk families 1-2 times a week and CAMHS learning disability clinical psychologists provide telephone support to parents of children with autism and learning needs.
- Drive-through DKA and HBA1c testing for children and young people with diabetes.
- Surgical teams see referred patients directly in A&E to avoid extra clinic appointments.
- COVID-19 intubation checklists and simulations enable rapid-cycle deliberate practice of paediatric resuscitation.
- Hazard logs specific to risk posed by COVID-19 are reviewed and updated weekly by senior management teams to mitigate risks.
Additional data and findings that have been emerging from the data collection tool are also available here.