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.

By meganpeng · April 30, 2020

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.