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Study to evaluate paediatric Accident and Emergency services within England and Wales

Waldron, Kim Elizabeth (1998)
M.Med.Sc. thesis, University of Birmingham.

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This Study aimed to describe paediatric Accident and Emergency (A&E) care within England and Wales, identify barriers to providing a service which complies with guidelines and to recommend action to improve child centred A&E care within the West Midland’s A&E departments. A questionnaire built upon interview data and previous studies was posted to senior nurses and consultants in the 247 A&E departments in England and Wales. Replies were received from 232 of these departments. A survey of training was incorporated in the main questionnaire and was also sent to every registered nurse working in A&E departments in the West Midlands, 98% of those nurses replied. Face to Face interviews took place with 88% A&E consultants and 70% senior nurses in A&E departments in a West Midlands interview sample. Follow up telephone interviews with every department interviewed were used to check conclusions, confirm earlier data and identify developments in the West Midlands departments. The results describe a comprehensive picture of A&E paediatric services in England and Wales. 72% departments state children are 29% of their attendees, 47% do not have a Registered Sick Children’s Nurse (RSCN) on their staff, and 45% departments are not visited by a paediatric consultant. There is no common system of assessment and prioritisation for children, 52% departments use triage systems for assessment which do not incorporate psycho-social and developmental needs, 41% departments do not keep separate records for paediatric attendees and 24% are unable to identify repeated attendees. A comparison of consultant replies with an earlier study by BPAS in 1985 shows encouraging improvements over ten years, a three fold increase in paediatric waiting room provision, threefold increase in paediatric treatment room provision and a 35% increase in RSCNs in A&E departments, yet there is a significant decrease in the number of departments able to retrieve previous attendance data. Training questionnaire comparison of A&E nurses in the West Midlands with those in the rest of England and Wales shows the West Midlands has significantly lower training in all aspects of paediatric A&E care, for example, Child Protection training is 52% greater outside the West Midlands and 26% A&E nurses in the West Midlands have received Advanced Life Support training as opposed to 68% in the rest of England and Wales. Barriers and Constraints to service provision are identified as: staff recruitment, loss of on-site paediatric support, difficulty in assessment of priority for children in a mixed adult/child workload and the availability of training. West Midlands developments identify an increase in RSCNs in A&E to 42% departments and a decrease of on-site paediatric units. Common issues for all A&E departments were identified as, availability of appropriately trained staff, availability of training for existing staff, no common form of audit and monitoring system and inconsistent communication networks. Recommendations are focused on improving service provision in West Midland A&E departments.

Type of Work:M.Med.Sc. thesis.
Supervisor(s):Bradley, Colin
School/Faculty:Faculties (to 1997) > Faculty of Medicine and Dentistry
Department:Department of General Practice
Subjects:RJ Pediatrics
Institution:University of Birmingham
Library Catalogue:Check for printed version of this thesis
ID Code:30
This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder.
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