G316(P) The impact of children’s ambulatory unit model of care on children’s emergency department flow

Aim To outline the impact on flow, quality of care and patient experience for children with urgent care needs presenting to the Children’s Emergency Department (CED) before and after introduction of a Children’s and Young People’s Ambulatory Unit (CAU). Methods Prospective baseline data was collected on patients presenting to CED across 2 days in 2018. Data on arrival time, length of stay (LoS), nature of presenting complaint and suitability for ambulatory care was collected for each patient. The CAU opened in 2018 for 12 hours a day 5 days a week. Following opening, live data was collected across 2 weeks. This was compared to baseline data to investigate the impact of this new service on patient flow through the emergency pathway. This then formed the basis of a dashboard for ongoing data monitoring. Results Baseline data revealed that 42% of total attendances at peak hours to CED were suitable for paediatric ambulatory care pathways outside of the CED. Analysis after opening revealed an average of 8.6 admissions per day. This has continued to rise to 16 per day by Winter 2018. Additional admissions from paediatric wards indicate the facilitation of early discharges and saved bed days. Length of stay in CED was significantly reduced. 54% of patients attending CED at baseline stayed for 2–4 hours. Following opening of the CAU, this dropped to 26%. Performance against the ED 4 hour target improved by 8% within 3 months of opening and is now consistently >95%. A substantial reduction in LoS in CED due to diversion of patients has contributed to reduced CED breaches, reduced strain on CED and an overall improved patient experience due to improved flow through the emergency pathway. Conclusion There are overwhelming pressures facing CEDs across the NHS, with a continued rise in CED attendances year-on-year. This project illustrates the positive impact that an ambulatory care model with limited opening hours can have on reducing this pressure.