6872 A quality improvement initiative on childhood healthy weight within the paediatric pre-operative department of a Scottish teaching hospital

Objectives Childhood obesity is a public health challenge worldwide and unhealthy weight in childhood is associated with adverse health outcomes both in childhood and later in adulthood.¹ In Scotland, there is a marked difference between the most and least deprived areas for children at risk of overweight or obesity.² These issues are reflected in the perioperative environment, yet the routine measurement of BMI centiles or intervening on unhealthy weight in this setting is not widely practised.³ We describe a quality improvement initiative to establish a pathway of BMI centile recording and referral to a local healthy weight service on the paediatric surgical ward of a teaching hospital. Methods We included all children and young people attending the paediatric surgical ward for an operation requiring general anaesthesia. We collected data over four weeks from 20th September until 14th October 2022 from patient records. These included patient characteristics (age, sex, height and weight), type of procedure and the Scottish Index of Multiple Deprivation quintile. BMI centiles were calculated from height and weight for each patient, and the clinical threshold of BMI ≥91st centile was used to define unhealthy weight. We then defined proportions of children for whom weight and height were recorded, and the distribution of BMI centiles. Results Of 114 children and young people included, 77 had sufficient weight, height and BMI centile data for analysis (figure 1A). Of these, 49 (63.6%) were male and 28 (36.4%) were female, with age ranging from 2 to 17 years old. Out of these 77 children, 63 (81.8%) were within the healthy weight range, 11 (14.3%) were overweight and 3 (3.9%) were underweight (figure 1B). 6 (54.5%) of the 11 overweight children were in the most deprived 20% in Scotland, and 8 (72.7%) of these 11 children attended the ward for a dental extraction procedure. Despite the identification of 11 overweight children, no referrals were made to the local healthy weight service. Conclusion In this initial phase of our quality improvement project, we identified the local burden of childhood overweight and obesity. We also identified key barriers to effective intervention. These included incomplete data recording, lack of staff training and continuity, and the challenge of having sensitive discussions on unhealthy weight on a high turnover surgical ward. Our findings underscore the need to standardise BMI centile recording in the perioperative setting and to improve referral pathways for supporting families with childhood weight issues. References Reilly J, et al. Archives of Disease in Childhood 2003. Primary 1 Body mass index (BMI) statistics Scotland, Public Health Scotland, 2021 Burton Z, et al. British Journal of Anaesthesia. 2021