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