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Reducing emergency admissions in children and young people

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Dr Ronny Cheung goes through the full list of indicators for child health, plus a case study on children’s epilepsy admissions in children.

Variation in the NHS well recognised. Put simply, the consequences of variation in healthcare are that patients are not receiving the most appropriate care, and the NHS is not getting the most from its resources.

Following the seminal work of Professor Jack Wennberg on healthcare variation in the US, the NHS Atlas of Variation in Healthcare has highlighted levels of variation in England across a range of indicators.

NHS QIPP Right Care has commissioned a suite of themed atlases, starting with a collaboration with the Child and Maternal Health Observatory on variation in healthcare for children and young people.

Many local providers and commissioners have already used variation analysis to great effect, as a starting point to identify and tackle the reasons for variation.

Case study

Tackling local variation: Luton’s approach to reducing emergency epilepsy admissions in children and young people

Various agencies covering services within Luton PCT identified that the area had the highest rate of admission for childhood epilepsy of any PCT in England, and (using the DMIT tool – see “Practical steps”) identified also that the rate was twice nearly every demographically similar PCT.

A local team, led by the community specialist epilepsy nurse, conducted local analysis to identify various opportunities for intervention. Findings were:

  • South Asian ethnicity over-represented in admissions
  • Pre-hospital care was suboptimal, by families and by paramedic staff
  • Variation in criteria for admission to hospital for epilepsy

Improvements were made at each of these critical points in the pathway, including:

  • Health education for South Asian children and families
  • Training in pre-hospital management by paramedic staff
  • Hospital admission criteria rewritten along with whole pathway guidance from regional paediatric epilepsy network

Data are currently being gathered to formally evaluate the effectiveness of these interventions, although results so far have been promising.

Case study courtesy of Liz Stevens, Specialist Paediatric Nurse, Cambridge Community Services

Child Health Atlas Indicators

  • Community child health expenditure
  • Immunisation coverage
  • Breastfeeding rates
  • Perinatal mortality rate
  • Eligible neonates tested for retinopathy of prematurity
  • Full term babies admitted to neonatal care
  • Readmissions and home-birth admissions to neonatal care
  • Emergency admissions for sickle cell disease
  • HbA1c measurements in Type 1 diabetes
  • Emergency admissions for diabetic ketoacidosis
  • Rates of inpatient admissions for mental health disorders
  • Proportion of children with statement of special educational needs
  • Emergency admissions for epilepsy
  • Duration of admission for epilepsy
  • Time from referral to assessment for hearing tests in newborns
  • Rate of grommet insertion
  • Emergency admissions for asthma
  • Admissions for bronchiolitis
  • Duration of admission for bronchiolitis
  • Rate of tonsillectomy
  • Rate of gastrointestinal endoscopy
  • Emergency admissions for inflammatory bowel disease
  • Orchidopexy performed within recommended timeframe
  • Rate of attendance to A&E
  • Proportion of children with life-limiting conditions dying in hospital
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