G508 A national picture of challenges faced by paediatric units in discharge of children with medical complexity. (25th October 2020)

• Record Type: Journal Article
• Authors: Salama, M; Shanahan, RK
• Is Part Of: Archives of disease in childhood. Volume 105(2020)Supplement 1
• Page Start: A181
• Page End: A181
• Publication Date: 2020-10-25
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2020-rcpch.433
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aim: The prevalence of children with medical complexity (CMC) has increased in recent decades. CMC often are subject to increased lengths of stays (LOS). Discharge teams within UK paediatric services are more heterogenous as compared to counterpart adult services. Our aim was to explore how discharge for CMC children was facilitated in UK paediatric units. Method: We obtained a list of all UK Paediatric units from the Royal College of Paediatrics and Child Health. We contacted all the units with a freedom of information request for 8 questions. Questions 1–3 were to ascertain knowledge base of numbers of CMC or high LOS inpatients. Questions 4–5 were around non-medical barriers to discharge and Questions 6–8 involved exploration of how discharge planning was facilitated. A second contact was made to non-responders. Results: Of 186 units, 13 duplicate or inactive departments were eliminated. Following the 2 contacts we received a response rate of 86%. Few units were able to reply to the specific question around our CMC definition. There was more clarity around LOS with 71% of units having <5 long stay patients. Of those who replied, just under half the units had patients with non-medical barriers to discharge. Housing, care and commissioning and social barriers were the most common. Tertiary centres were more likely to have non-medical barriers to discharge. Discharge was mostly coordinated by nurses. 8% of units had a discharge coordinator. There were links to charity support in a large proportion of cases with hospices being most common. Charities such as Wellchild, Roald Dahl and others were mentioned. The most commonly cited paperwork used by this group of children were advanced care plans and hospital passports. Conclusion: Our responses have demonstrated the similarity of challenges faced in supporting CMC and their discharge. CMC numbers are not routinely collected which may mean less visibility of the challenges that are faced. We are seeking to be part of a workstream to share good learning and drive service development for this growing and yet vulnerable group of patients.