The number of children and young people being seen in hospital emergency departments rose by over 7.5% between 2014/15 and 2015/16, equating to 4.4 million attendances - a trend that is putting growing pressure on hospital services, according to the Royal College of Paediatrics and Child Health (RCPCH).
In line with this growing demand, the number of Short Stay Paediatric Assessment Units (SSPAUs) across the UK has increased from 144 to 178 in the last 8 years. An SSPAU is hospital based facility in which infants, children and young people with acute illness, injury or other urgent conditions can be assessed, investigated and observed and treated with an expectation of discharge in less than 24 hours. Figures show that approximately 85% of all unplanned admissions are isolated short stays of under two days, with 0-19 year olds increasingly staying for less than 24 hours.
The RCPCH's 'Standards for Short Stay Paediatric Assessment Units', marks the first time a national/UK wide set of standards has been published for SSPAUs, and reflects the fact that these units are becoming a key way of treating infants, children and young people quickly and effectively. They are often the hub for coordination and delivery of Emergency Ambulatory Care of infants, children and young people and play a major role in preventing admission to inpatient wards, ensuring children are home again with their families.
Dr John Criddle, Clinical Lead for the SSPAU standards, said:
"The increased demand on hospital services is well documented, and infants, children and young people are a large proportion of those being seen in hospitals - with under 15's accounting for 2.5 times the number of attendances than the over 80's. Our priority is to make sure unwell children are seen promptly by the right healthcare professional in the most appropriate setting. For some this will mean time in hospital and treatment on a ward, but in general, children shouldn't be admitted to hospital if it is possibly avoidable. It is unsettling for the child and the family if they are admitted for less than a day, when in fact they could be treated just as well in a short stay unit. It may reduce family disturbance all round, result in more effective treatment and has the potential to reduce costs due to fewer admissions and shorter length of stay."
The RCPCH's standards cover the governance of SSPAUs; the environment and hours of operation; recognition and management of the deteriorating child; the promotion of ambulatory and community based care; supporting services; communication with children, young people and families, staffing and training. Examples include:
- All infants, children and young people accessing the SSPAU must have a standardised initial assessment, including pain score, within 15 minutes of arrival
- A Standard Operating Policy (SOP) must be in place with a named senior paediatrician and named senior children's nurse responsible for the management and coordination of the service
- A paediatric consultant (or equivalent) is readily available on the hospital site at times of peak activity of the SSPAU and is available to attend the SSPAU at all times within 30 minutes
- All clinical staff have appropriate, up-to-date paediatric resuscitation training
- A child and young person friendly and developmentally appropriate play area must be available for all infants, children and young people
- Hours of operation should match times of population demand of the SSPAU - which is likely to include the afternoon and evening, including Saturday and Sundays
- The SSPAU must have robust links to acute services both in primary and secondary care
- Children and young people and parents and carers receive regular updates on their condition and management plan, and are fully involved in the decision making process
Dr Criddle added:
"Already hundreds of SSPAUs across the country are providing high quality care to thousands of children every day. We hope that these clear set of standards will help SSPAUs become even more effective as they continue to play a central part in the provision of hospital emergency care. Demand on the system is never going to decrease, but adapting how and where care is delivered can help cope with the pressures more efficiently."