6725 Greater Manchester sudden unexpected death in childhood, a two year audit: benefits of a consultant delivered service?

Objectives The Greater Manchester (GM) Sudden Unexpected Death in Childhood (SUDC) service meets statutory requirements1 via a service delivered by on-call Consultant Paediatricians. A two-year regional audit considers service performance against published data from National Child Mortality Database thematic report on sudden child deaths.2 Methods A total of 80 cases were audited, 40 per annum April 2021-April 2023. This included all closed cases, (post Child Death Review Meeting – CDRM) and further random sampling of open cases, so each audit-year cohort numbered 40, preventing data being skewed by less-complex, earlier-closing cases. In 2021–22, this encompassed 31 closed and 9 ongoing cases; in 2022–23, there were 24 closed and 16 ongoing cases. Data was gathered from audit forms (completed as standard after CDRM) and/or electronic case records, as required. Results Over 95% of infant deaths in GM had a joint agency home visit completed (vs 65% nationally2); over 66% of cases aged >1 year – 2). In GM across the two year period for eligible cases (CDRM complete at time of audit) 42% of infant deaths remained of 'unascertained' cause. Nationally, 52% under 1 year old deaths were of unascertained cause when reviewed by Child Death Overview Panel.2 Joint history and examination by police and SUDC Paediatrician were undertaken in over 65% of cases. In over 70% of cases, a professionals meeting occurred within one working day of death. Bereavement support was offered to parents on the day of their child's death in at least 85% of cases. Over 66% of child deaths occurred outside of Monday-Friday, 9am-5pm. Conclusion This audit demonstrates that a Consultant-led model is able to deliver key aspects of joint agency working, at higher rates than national average. This is likely a reflection of the availability of the on-call clinician. Levels of unascertained infant deaths in GM over the two-year audit-period were lower than national data. This new, unexpected finding requires further exploration. It is possible that the provision of a Consultant Paediatrician for SUDC cases is increasing the likelihood of ascertaining cause of death. A majority of cases occurred outside of 'office hours', supporting the case for an out of hours clinician to support the SUDC process. Overall, the audit demonstrates measurable benefits of the Consultant-delivered service and data will be continue to be collected and analysed annually. References HM Government, Child Death Review Statutory and Operational Guidance (England), October 2018. National Child Mortality Database, Sudden and Unexpected Deaths in Infancy and Childhood Thematic Report, Data from April 2019 to March 2021, Published December 2022.