Christine Edwards

Designing a Paediatric early discharge follow up nursing service (PEDFUNS)

Background

The project aimed to design a paediatric early discharge follow up nursing service (PEDFUNS) to prevent unnecessary readmissions to the general practitioner, emergency departments and children’s wards. 

It was intended that the PEDFUN service would provide appropriate health information on managing current symptoms, give information to aid recognition and the need for referral. It would also offer to parents reassurance, while abiding by NICE guidelines for best practice.

 

The advantage to nursing is easy access to best practice information via the app, easy recognition of when situations require further exploration, the opportunity to intervene when complications are identified and continuing opportunities for compassion and care through professional contact when there are concerns


Published research in areas offering this type of service was reviewed. It was evident from the research that similar services were offered in a variety of formats by different organisations that suited their particular organisational and community structures. This lead on to a realisation that there was a need for technology that could offer this service in a more accessible and effective format.

A digital PEDFUNS has the potential to increase parental and carer access to current health information, to assist early recognition of concerning signs and symptoms. It can also be a means of reassurance and identifying home treatment options for mild health concerns. 

healthcare app

Savings to the NHS health acute and primary service are likely to be significant as presentations are decreased. The advantage to nursing is easy access to best practice information via the app, easy recognition of when situations require further exploration, the opportunity to intervene when complications are identified and continuing opportunities for compassion and care through professional contact when there are concerns.

Aims

To develop an effective PEDFUNS.

children with dad over the tablet

 

A digital PEDFUNS has the potential to increase parental and carer access to current health information, to assist early recognition of concerning signs and symptoms

Activity to date 

The early project activity was focused on reviewing the research literature regarding PEDFUNS in general and evaluation of services using the approach.

It became evident from the available research that a uniform PEDFUN service would not work for all organisations or communities. It also became apparent that there was a move by some organisations towards technology that would provide such a service.  

This lead us to an entirely new exploration of the literature and the digital world. This particular research was a little frustrating as there was plenty of suggestions and visions about what technology was going to be created by various health and non-health organisations, however, there appeared to be very little substance behind the claims of what could be achieved. 

 

It became evident from the available research that a uniform PEDFUN service would not work for all organisations or communities

 

I was fortunate to find and be able to communicate with two digital application developers. These developers had already created digital programmes that while not having the specific function of a PEDFUNS programme, certainly had the potential to develop it as an add on to existing programmes.  

Parallel to the research process I was in regular communication with my Celebrating Nursing Practice mentor. We progressed the project to the point of discussing a trial project in the hospital my mentor was linked with. 

Unfortunately, due to being an agency nurse and not in a NHS children’s ward, I was not in a position to progress the project to a trial stage without access to stable NHS site.

Savings to the NHS health acute and primary service are likely to be significant as presentations are decreased

Outputs to date

The research which deepened my knowledge and understanding of what was needed for a technology PEDFUNS. A plan was created for implementation of a digital PEDFUNS within an acute children’s service which focused on the follow up of removal of tonsils and adenoids.

Contact has been made with two technology developers who have already created apps that had the potential for add-ons. These add-ons appeared, from preliminary discussions, to be able to meet the needs of a PEDFUNS.

asian girl hospital
The project when in operation is expected to cut down on time spent in emergency departments, GP surgeries and in children’s wards. Parents and carers are likely to feel reassured and empowered by the information that they obtain from the app and can also find an easily accessible pathway to clinician contact if they have ongoing concerns

Lessons learned 

I spent a lot of time researching the extensive field of recent digital setup companies, some NHS and some private that are making forays into this area. Unfortunately, it appears most are in the early stages of development and the expertise has been in winning health contracts rather than into the practice of developing the apps.  

I have significant reservations about going ahead and developing a digital application without making contact with the many digital innovation projects that are starting up within the UK and funded through by the NHS. Unless there is a more joined up approach, I have concerns that there is the potential to replicate the current disjointed health services that has isolated pockets of expertise operating independently of each other. There has been significant funding given to many organisations to develop digital health technology. The resulting technology may or may not translate into comprehensive apps that that can be of uniformly high standard and equally accessible to the public and health clinicians. I believe a project of the importance and potential reach of the one I am proposing warrants that significant time, funding and access to all current similar innovation projects be integral to its development. 

open book

I had anticipated being able to progress discussions with the app developers I had contacted, further explore innovation agency activity and look further into the new data protection laws. I had also anticipated that I would be able to, through my mentor, make contact with a site to trial the app. This would include engaging staff, gaining ethics approvals and resource development for the trial in collaboration with the trial site clinicians. Unfortunately, none of these activities were possible due to time constraints and competing priorities. 

I also had difficulty creating a start point for progressing the project beyond the research phase. I felt I could not progress any of the above activities on my own as an independent clinician. Until I had trial site buy-in I would be wasting the time of those I contacted as I was unable to present myself and the project as formally supported.  

Reflections on impact

The project when in operation is expected to cut down on time spent in emergency departments, GP surgeries and in children’s wards. Parents and carers are likely to feel reassured and empowered by the information that they obtain from the app and can also find an easily accessible pathway to clinician contact if they have ongoing concerns.

 

Initially the trial project would use a phone survey to access helpfulness of the trialled app. If the project was progressed to fruition it would have a feedback survey embedded within the app 
QInitially the trial project would use a phone survey to access helpfulness of the trialled app. If the project was progressed to fruition it would have a feedback survey embedded within the app

 

QInitially the trial project would use a phone survey to access helpfulness of the trialled app. If the project was progressed to fruition it would have a feedback survey embedded within the app

 

QInitially the trial project would use a phone survey to access helpfulness of the trialled app. If the project was progressed to fruition it would have a feedback survey embedded within the app

 


The way forward

I believe that the technology could be extremely helpful in empowering parents and carers of children to make informed decisions on children’s health. It could be used as both a provider of health information, an alert to red flags and helping parents identify uncertainty around a child’s health status. Signposting to the appropriate resources is also integral to the project.

The technology is available to create many add-on programmes onto a generic programme for parents. One of the technology providers I contacted, a paediatrician, designed a generic paediatric programme for sick children in such a way that many adds-on could be included in the programming of the app. There is therefore the potential to cover vast areas of children’s health and make it easily accessible to parents.