Aims The 2012 NHS mandate recommended reduction in the length of stay for inpatients, to improve the care of patients with both long term conditions and those with acute problems. Reference was also made to improving patients' experience of care.In paediatrics, these visions are most easily realised within ambulatory paediatrics. In April 2014 a pioneering ambulatory care service was established at our hospital, with 'Healthcare at Home' (HAH). The first childrens' service of its kind, it is a consultant led, nurse delivered model of acute paediatric care. The nurses visit children up to four times a day, to administer medication, perform observations and provide clinical review. The observations and notes are recorded electronically. A daily consultant-led virtual ward round is conducted with the HAH nurses, facilitated by review of the patient's electronic health records. The initial goal was to enable early discharge from hospital, with future aspirations to facilitate admission avoidance with direct admission to HAH from the paediatric emergency department. Methods Activity data for the first 9 months has been analysed and patient experience feedback has been evaluated. Results 78 patients have been accepted onto the HAH service to date, giving 815 visits, and saving 389 bed days. 796/815 (97.7%) were for administration of IV medication, with 48% for medications needing to be administered more than once a day. Referrals are increasing, with the majority from the general paediatrics service (90.5%). Orthopaedics, gastroenterology and neurosurgery contribute the remainder. There have been 28 episodes of patients re-attending following transfer to HAH; 22/28 (78.6%) have been due to problems with intravenous access, and 6/28 (21.4%) for clinical review. No patients have required readmission to the hospital. Patient feedback has been excellent with 100% of questionnaire responders saying they would recommend HAH to their friends and relatives. Conclusion HAH is in its infancy but, thus far, has delivered exemplary clinical care. As stated in the NHS mandate, improving the experience of patients' and their families is essential The development of a flexible and robust community nursing service, which provides excellent acute clinical care is a proven means of facilitating this. Aims The Friends and Family Test (FFT) is currently used nationally in adult acute care settings, and from April 2015 it will be compulsory for all children and young people (or their parents) to be offered the question. Although the guidance suggests wording for younger patients, there is no evidence that it has been rigorously tested with them. Our research therefore explored children's views of the FFT question including wording, response options and overall design, to propose the most suitable version for children and young people. Methods A focus group with young patients explored views on patient feedback and different versions of the FFT. This informed the development of several child-friendly versions of the question, differing in ...

BackgroundThe NHS is facing unprecedented pressure to provide care with an ever decreasing budget. Inspired by the Choosing wisely initiative and a recent document by the Academy of Medical Royal Colleges, which have documented positive changes in improving patient care by highlighting areas of overdiagnosis and overtreatment.MethodsA workgroup of junior and middle grade doctors and an operational manager identified common presentations to the paediatric ED. Seven presentations were chosen and the most common diagnostic tests ordered listed, which were compared to national guidelines. The cost of all of the tests were sought and the difference calculated.ResultsThe chosen presentations to the paediatric ED with proposed changes are: pneumonia, bronchiolitis, gastroenteritis, cellulitis, asthma, febrile convulsions and ankle/knee injuries. Spot check initial results showed significant potential cost savings without compromising best patient centred care. There would also have been a significant reduction in potential pain and discomfort to the patient and a reduction in unnecessary radiation exposure.ConclusionsBetter patient care can be achieved by following national guidelines more strictly, with the added benefits of less waste and cost savings. We have calculated as a conservative estimate, that if our department reduced only 30% of the identified unnecessary tests, a saving of £20,000 per annum could be achieved.