BackgroundHeart murmurs are commonly detected at the Newborn Infant Physical Examination (NIPE). Routine use of antenatal and pulse oximetry screening means isolated murmurs are unlikely to be due to missed critical Congenital Heart Disease (CHD). We have developed a local guideline for assessment and follow up of these babies and share our experience of this service.AimTo assess the outcomes of neonatal heart murmurs detected on routine NIPE and review utilisation of neonatal and PEC (Paediatrician with Expertise in Cardiology) clinics.MethodsAll babies with murmurs on NIPE over one year (July 2015–June 2016) were retrospectively identified from the NIPE Smart system. Data was gathered from electronic and paper hospital records. All babies had follow-up outcomes for minimum 6 months. Babies with antenatal CHD diagnosis or having NICU admission were excluded.ResultsOut of about 6000 deliveries, 139 patients had murmurs detected (50.4% Male). 96 murmurs were noted at <24 hours of life. 132 babies (95%) had pulse oximetry, of which 3 were abnormal. 134 (96%) had inpatient middle-grade/consultant review. All ECG (5 patients) and CXR (2 patients) were normal. Five patients had in-patient echocardiograms (three normal and two showed Ventricular Septal Defects [VSD]). 53 patients (41%) had murmur at discharge, of which 51 were referred to neonatal clinic, seen at average 5.5 weeks from discharge. Of these 51 patients, 13 still had murmur in clinic; Five had murmur resolution under neonatal follow-up, three are under neonatal follow-up with persisting murmurs (two had echocardiogram showing small muscular VSDs) and five were referred to PEC clinic. These five patients were seen in PEC clinic on average 11 weeks from referral. Three were discharged following normal echocardiograms, one referred to paediatric cardiology and the 5th remains under PEC follow-up.ConclusionMost murmurs in neonates with normal pulse-oximetry are innocent, only 4% diagnosed with underlying CHD.CXR and ECGs have little role in the routine investigation of isolated neonatal murmurs. The current department referral pathway is working well with only 10% of referrals to neonatal clinic requiring PEC clinic referral, thus optimising PEC clinic utilisation.

Aims Child and Maternal Health (ChiMat) Observatory Data indicate our institution has higher Paediatric Emergency Epilepsy admissions and length of stay, compared to other PCTs in England. This report has been referred to by Commissioning Groups when reviewing and commissioning services. The information produced by ChiMat is based on data from the hospital’s coding department, who determine the admission reason from discharge letters completed by junior doctors. We carried out a retrospective audit to review: The accuracy of coding Medical management of Paediatric Emergency Epilepsy admissions. Methods We reviewed the medical notes of all patients coded as having a Paediatric Emergency Epilepsy admission during 2011. There were 78 patients during this period, and information was collected using a standardised proforma. Inappropriately coded patients were excluded from analysis in the second part of the audit. Results 10 of the 78 patients (12.8%) were exclusively under the care of the adult physicians, with age range 16–19 years. Of the other 68 patients, 15 were incorrectly coded (22%). Review of the medical management in the remaining 53 admissions, showed areas for improvement in medication adherence, patient education and awareness, and community management plans. Conclusions This study has shown the importance of accurate data coding, as this is used to review the service we provide, highlighting exceptional practice as well as areas which require improvement. Variation in practice and value in healthcare are the current quality indicators which are used, to compare hospitals and clinicians, and to continue the quality improvement cycle. It is therefore in the interest of all to engage with clinical coding to ensure accurate, robust data is being used. Our audit has led to more streamlined management of patients with epilepsy, including the consideration of more community-based management plans and proposal for a Paediatric Epilepsy Specialist Nurse. There has also been quality improvement effects, including introduction of a weekly epilepsy-related admissions report which is reviewed for accuracy, monthly epilepsy peer-review meeting to review all admissions and challenging cases, importance of accurate coding on discharge letters being emphasised to junior doctors at induction, and introduction of a checklist for management of patients with epilepsy.

BackgroundSupra-Ventricular Tachycardia (SVT) is the commonest pathological tachycardia in newborns. West Midlands hospitals generally rely on the Advanced Paediatric Life Support (APLS) guideline to manage Neonatal SVT. This guideline is not neonate specific and Neonatal advanced nurse practitioners are not APLS trained.AimOn behalf of the West Midlands Children’s Cardiac Network, we designed a survey to explore local practices, understand the dilemmas faced with neonatal SVT, as well as to determine the acceptability of a neonatal SVT guideline.MethodsAn online questionnaire was designed using a survey programme, incorporating 10 questions on aspects of neonatal SVT and local practices, and this was sent out via email to all paediatric and neonatal consultants in the region and results collated using the survey software.ResultsThere were 43 responses, of which 74% were paediatricians, 19% neonatologists and the remainder PEC’s. Responses covered 80% of regional trusts. 67% used the APLS guideline to manage neonatal SVT, with 3% using a local guideline. However 30% discussed management directly with a paediatric cardiologist. Of those that used the APLS guideline, 36% did this because the baby was haemodynamically compromised. For non-haemodynamically compromised SVT, 84% said they would use vagal manoeuvres as first-line management. If vagal manoeuvres and IV Adenosine failed, 93% of responders would contact a paediatric cardiologist as their next management step. A free-text question on the most difficult decision making dilemmas when faced with neonatal SVT had common comments of what chemical cardioversion could be used if adenosine failed, timing for DC Cardioversion, and when to transfer to regional centre. In terms of acceptability of a regional guideline, 70% said they would be happy to use this. An additional question on out-of-hours availability of ECG machines, showed that 10% of responders had no access to this.ConclusionThe majority of responders indicated that they would happy to use a regional guideline and so we have used the results of this survey to inform this guideline, including guidance for the common dilemmas faced, with clear flowcharts, as well as appendices on the common drugs used. Finally, we would suggest that this guideline could be applicable nationally, via the PECSIG group.

BackgroundNon-attendance to outpatient appointments results in loss of financial income and reduces the utilisation of clinics. Currently our trust sends automatic text message reminders to parents 7 days prior to the child’s appointment. A recent trial showed a reduction in “Did not attend” (DNA) rates in adult medicine by stating appointment costs in the text message reminder1.AimTo conduct a trial to assess the impact of altering text message reminders to include a persuasive message, on DNA, cancellation and rescheduling rates at our hospital.MethodsIn two paediatric specialties, we piloted three new text messages (Table 1), which were each sent for one week consecutively. At the end of the trial period the DNA, cancellation and rescheduling rates were compared between the three trial texts and original text message. Additionally, a written survey was conducted in the affected clinics to gain feedback on the text messages and assess their influence.Abstract G200 Table 1Text message reminders sentResults1378 text message reminders were sent during the three week trial, on average 460 texts per week. The DNA rate (Figure 1) for the original text was 9.1%, which dropped to 8.7% for text 1, 7.8% for text 2, and 8.3% for text 3. Cancellation and rescheduling rates showed a reduction of around 2% for each new text. From the survey, we received 58 responses, of which 48% felt the trial text made them more likely to attend the appointment. The main message preferred was text 3.Abstract G200 Figure 1Results of text message reminders on DNA, cancellation and rescheduling ratesConclusionThis study shows the impact that a simple cost-neutral change to the content of a text message reminder can have on outpatient attendance, with the most impressive being from including the cost of the appointment. Reduction in cancellation and rescheduling rates also suggests the change in text message made parents more likely to attend the given appointment, which was emphasised by the survey. The study also reinforces the role of text message reminders in improving outpatient attendance.ReferenceHallsworth M et al. Stating Appointment Costs in SMS Reminders Reduces Missed Hospital Appointments:Findings from Two Randomised Controlled Trials. PLOS ONE 2015;10(9):e0137306