Bradford Teaching Hospitals Foundation Trust – Children and young people’s ambulatory care experience

Children and young people account for 30 per cent of emergency department attendances in Bradford. But in 70 per cent of these cases, the patient is discharged after an initial observation – only five per cent are eventually admitted to a hospital bed. This means that the majority of children and young people attending the ED, often a busy and unsettling place, likely never actually needed to be there.

To provide an alternative to hospital referral or admission, the trust set up the Ambulatory Care Experience (ACE) team. Developed and implemented in a period of just over four months, this multidisciplinary, multiprofessional and multiagency team cares for children and young people in their own homes, with a virtual ward setup. Consultant paediatricians take clinical responsibility for these patients from the point at which primary care, the emergency department or the children’s assessment unit makes a referral.

The first pathway developed along these lines was for children experiencing wheeziness. Hospital attendances and admissions were prevented for some 83 of these children, who were able to remain at home for the full length of their acute illness. All were managed remotely by a paediatrician. A total of 105 bed days have been saved to date.

The success is such that the model is now being rolled out for other conditions. New pathways are planned for areas including gastroenteritis, croup, bronchiolitis and neonatal jaundice. A neighbouring hospital has already shown interest in replicating the approach.

Read a detailed case study about this project at HSJ Solutions


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  • Healthy London Partnership and The Metropolitan Police Service – Handover process for voluntary mental health patients in emergency departments
  • Milton Keynes Clinical Commissioning Group – Milton Keynes High Intensity User Scheme
  • North East Essex CCG – High Intensity User Project
  • North West London CCGs and Greenbrook Healthcare – Urgent treatment centres
  • Northern Care Alliance and North West Ambulance Service Trust – Heywood, Middleton and Rochdale Emergency Assessment and Treatment Team
  • Partnership of East London Co-operatives – Integrating primary and urgent care
  • The Pennine Acute Hospitals Trust – Co-design and co-production of a sensory space in the children’s emergency department at North Manchester General Hospital
  • West Midlands Fire Service and University Hospitals Coventry and Warwickshire Trust – Back Home Safe and Well

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