Background and objectivesFor many years now, the paediatric units of hospitals in south-East France (including Monaco and North Corsica) have been offering collaborative management of paediatric patients within healthcare networks (eg, safe births, paediatric haematology and oncology). To improve the quality of the service on offer, the medical teams have set up practice appraisal initiatives based on the clinical audit method proposed by HAS. The broad objectives are to improve the care delivered to paediatric patients, harmonise patient management on a regional scale, make proper use of prescriptions, and improve efficiency (tests, treatments, and costs).ProgrammeThe programme has involved over 30 paediatricians in seven hospital paediatric units. The diseases managed within the project were chosen on the basis of their health impact (eg, potentially serious disease), the frequency of the disease, the need for coordinated action (involvement and coordination of two units such as the emergency department and ward), and the long-standing implementation of a common medical protocol which facillitates training.ResultsThe programme has been running for 2 years and two audits have been completed (infections in mothers and newborn, urinary infection). They have led to a common shared evaluation culture among the teams, a consensus on the need for continuous updating of care protocols, better professional practices (eg, orders for tests, appropriate antibiotic use), and extension of the programme to other diseases. Corrective actions have concerned:inconsistent practices within one and the same team especially during night duty when a combination of three antibiotics may be prescribed for infections,protocol violations such as a tendency to overprescribe,technical aspects of the protocol: (i) validity of bacteriological test results for urinary infections; (ii) criteria for antibiotic treatment of infections in the mother and newborn, (iii) lack of instructions for all clinical situations encountered,need for the collaboration of other health professionals (laboratory staff, clinical pharmacists).Discussion and conclusionOur initiatives have had a positive impact at three levels:treatment: optimisation of antibiotic treatment (two drugs instead three);technical issues: changes in urine collection method;managerial: a collective change in professional practices.Current work is on the development of clinical practice indicators to assess quality and safety and on the assessment of the health economics impact of our initiatives.Contexte, objectifsDepuis de nombreuses années, et à l'initiative des médecins, les services de pédiatrie des hôpitaux de la région PACA-Est Haute Corse Monaco assurent une prise en charge collaborative, en réseau, des enfants malades de ce bassin de population. Plusieurs réseaux sont agréés, reconnus et financés par les tutelles (Réseau Sécurité Naissance, réseau Rheop en Hémato-Oncologie pédiatrique, etc).Le souci partagé par chacune des équipes d'améliorer la qualité de la prestation proposée aux...
