Multi-method evaluation of a paediatric ambulatory care unit (PACU): impact on families and staff

• Published in: Archives of disease in childhood Vol. 93; no. 8; pp. 681 - 685
• Main Authors: Blair, M, Gore, J, Isaza, F, Pajak, S, Malhotra, A, Islam, S, Vigneswaran, T V, Lachman, P
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.08.2008; BMJ; BMJ Publishing Group LTD
• Subjects: Ambulatory care; Ambulatory Care - standards; Ambulatory Care Facilities - standards; Biological and medical sciences; Child; Child Health Services - standards; Child, Preschool; Children & youth; Continuity of Patient Care; Demographics; Departments; Ethnicity; Families & family life; Female; General aspects; Health participants; Hospitals; Humans; Infant; Infant, Newborn; Interviews; Male; Measurement Techniques; Medical referrals; Medical sciences; Miscellaneous; Nurses; Observation; Parents; Parents & parenting; Parents - psychology; Patient Satisfaction; Patients; Pediatric nursing; Perceptions; Physician-Patient Relations - ethics; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Questionnaires; Referral; Referral and Consultation - statistics & numerical data; Response rates; Response Rates (Questionnaires); Semi Structured Interviews; Studies; Telephone Surveys; Human; Evaluation; Pediatrics; Methodology; Family study; Health staff; Health care staff; Health service; Method; Unit; Care; Family environment; Ambulatory; Technique; Child; Public health
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.2006.115386

Aim:To assess the impact of a purpose-built, short stay paediatric ambulatory care unit (PACU) on the patient journey and perceptions of parents, staff and referrers.Methods:Multi-method evaluation, including a parent survey (n = 104), patient journey mapping (n = 10), staff interviews (n = 10), a referrer survey (n = 16), routine activity analysis, and a comparison with the A&E service (A&E parent survey: n = 41).Results:Almost all parents attending PACU (94%) were satisfied with the service and significantly more likely to feel “very” satisfied than parents attending A&E (PACU: 51%, A&E: 31%; p = 0.03). Further, over three quarters (77%) of PACU parents preferred the new model to traditional A&E services. They reported receiving sufficient information (93%), reduced anxiety (55% anxious before service, 13% anxious after; p<0.001), “quick” waiting times (median: 35 min), and enhanced confidence (87%) and understanding (89%) in dealing with their ill child. The number of stages in the patient journey was reduced from six (“traditional” A&E pathway) to four (PACU pathway). Staff and referrers reported this was a “superior” model to A&E, but that improvements were required around appropriate referrals and the need for more multi-disciplinary protocols and liaison.Conclusion:Our study suggests that the PACU model is perceived to be an effective alternative to standard A&E services for the assessment and early management of acutely ill children and their families attending a hospital. It is highly valued by users, staff and referrers and enhances the patient journey. Lessons learnt include the need to enhance multi-disciplinary processes and clarify the role of this form of acute care provision in the wider healthcare system.