1476 Rapid discharge of children with medical complexity (CMIC) from a specialist children’s hospital during the first wave of the coronavirus pandemic

• Published in: Archives of disease in childhood Vol. 106; no. Suppl 1; pp. A385 - A386
• Main Authors: Salama, Mary, Shanahan, Rachel, Kershaw, Melanie JR
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.10.2021; BMJ Publishing Group LTD
• Subjects: Abstracts; Adaptation; Boundaries; Children; Complex patients; Coronaviruses; Global health; Health care; Hospitals; Housing; Length of stay; Occupational Therapy; Pandemics; Patients; Pediatrics; Public health; Resistance (Psychology); Severe acute respiratory syndrome coronavirus 2; Stakeholders; Training
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2021-rcpch.670

BackgroundCMIC are well described to have high health care use and long lengths of time in hospital.1 In our specialist children’s hospital. Our specialist discharge team usually have 18–30 children with the most complex journeys on our caseload. A significant proportion of these children have non-medical barriers to discharge which include care and commissioning, housing, parental training and need for adaptations.2 Many of them were perceived to be at increased risk of deterioration should they have caught the SARS-CoV-2 variant.ObjectivesWe undertook to provide a rapid discharge for this group of children during the first wave of the pandemic.MethodsRapid discharge was undertaken using the creation of a virtual telephonic and then zoom space to bring together key stakeholders. It was led by silver command and fed into organisational architecture during the pandemic. Stakeholders included clinical teams across institutional boundaries, therapies, social care colleagues and voluntary sector collaborators. Rapid PDSA cycles enabled us to adapt to the changing landscape. Initially the meetings were three times a week, decreasing in frequency to once weekly until the present time. We relied on existing relationships and built new connections.ResultsFrom the start of the first lockdown 23rd March 2020 until the easing of restrictions on 15th June 2020 we discharged 23 long stay patients. The length of stay prior to discharge varied from 19–866 days. The median time to discharge in this group was 22 days from the start of lockdown. The barriers to discharge varied from need for housing and care provision to social care support. Apart from improvement in length of stay we also were able to solve problems innovatively by working together. Cots and white goods were sourced through social care funds and ordered on amazon by our occupational therapists. Donated housing capacity was identified by our covid command structure facilitated families moving there temporarily instead of staying in hospital. A local hospice was able to provide care for the most complex of our patients whilst awaiting onwards placements in social care and carer training. The feedback from stakeholders following discharge was used to refine processes. There were no adverse outcomes or readmissions.ConclusionsThis period of global health crisis has been devastating for many. In amongst the tragedy, there are glimmers of learning that would not have been achieved without this unprecedented challenge. This rapid discharge process is one such glimmer. It demonstrates that by working together across agency boundaries, thinking innovatively and putting the children and families at the heart of what we do, we can effect rapid change. We now need to harness and retain this learning to be able to continue sending children homeReferencesCohen E, Kuo DZ, Agrawal R, Berry JG, Bhagat SK, Simon TD, Srivastava R. Children with medical complexity: an emerging population for clinical and research initiatives. Pediatrics 2011 Mar;127(3):529–38.Salama M, Shanahan R, Bassett E, et al. G157(P) A toolkit to identify barriers to discharge for children with medical complexity. Archives of Disease in Childhood 2020;105:A54.