Building a clinical network for paediatrics in Ireland
Professor Alf Nicholson Presentation 6th October re Model of Care
Has anything really changed?
Background
changes in disease priorities for child health ▪ improved standards of living ▪ many ‘killer’ diseases have disappeared ▪ chronic and complex disabilities more prevalent ▪ emotional and behavioural problems affect 10 – 20%
changes in parental expectation ▪ loss of confidence in primary care provision ▪ faster access to specialist care ▪ ‘informed’ client group
changes in healthcare provision ▪ reorganisation of infrastructure
Longstanding health conditions in 3 yo’s
Population prevalence estimates by IPH
Health inequalities are evident at an early age
Boys > girls
Parental smoking is important
A succesful and sustainable health system – how to get there from here Fineberg NEJM 2012 ;366:11:1020-‐1027
Redouble efforts to enhance the quality and safety of health care Keep patients out of hospital Find out what families want and honour it Smooth patient flow through the system Learn from peers and the evidence Value accountability above autonomy Adopt many strategies to reach one big goal
Stake-holder dialogue
Guiding principles for a national model of care
Smooth patient flow through the system
Senior decision maker availability Paediatric assessment units Rapid response clinics Strengthen role of ANP’s , CNS’s and AHP’s OPD referrals from primary care to general paediatrics in the first instance Improve radiology access Nurse-‐led discharge from time of admission
Keep children healthy
Promotion of breast feeding
Immunisation uptake > 95%
Healthy eating + exercise
Screening (IEM’s , CF , pulse oximetry , Universal hearing screening + DDH screening)
First contact care
Improve primary/secondary interface
GP training in paediatrics (at least 6 months)
Maternal and child health nurses
Web-‐based parental education
GP algorithms in app format for common paediatric conditions
Strengthen regional + local care via integrated networks
Agreed national guidelines implemented across the system
Regional centres with paediatric radiology , non-‐specialist surgery , paediatric pathology and paediatricians with a special interest
Outreach from tertiary and regional centres
Listen to children and families
National Charter for children and young people
Meaningful involvement in planning of future healthcare
Hospital in the Home concept
Quality improvement
Local leadership + commitment to QI and data collection
National PEWS with education of staff
Quality indicators in Paediatrics
Adverse event reporting with shared learning
Pivotal role of general paediatrics
Acute unscheduled care
Rapid response clinics + hotlines for GP’s
Holistic care of children with complex problems
Scheduled care for a broad range of conditions Areas of special interest
Retrieval services
24/7 neonatal transport a great success
PETS an urgent priority
Transfers and retro-‐transfers
Additional intensivists required
A future workforce
Vulnerable and disadvantaged groups
Community supports (eg Triple P Parenting Programme)
Higher mortality from injuries and higher emergency department attendances
Child protection
A responsibility for all who look after children
Child sexual assault services
National guidelines
Learn from international experience
Look to the Swedish model
Close links between primary and secondary care with co-‐location with paediatricians and community nurses in health centres
Significant nursing role
Plan for the future
Telemedicine and smart phone technology
Changing morbidity with ongoing allergic disease surge in incidence
Increased mental health and psychosomatic illness
Improved survival of extremely preterm infants , complex heart disease , childhood cancer and chronic renal disease