6110 Review of all retrievals (ROAR): learning from patients requiring emergency transfer at a district general hospital

Objectives Emergency transfer of acutely unwell children is relatively common and logistically challenging. Being prepared is vital. As with any critical event, they should be learned from as part of effective clinical governance. We have established a regular multidisciplinary meeting 'Review of all Retrievals' (ROAR) to improve standards of care for this vulnerable patient group, their families and staff alike. Methods ROAR was established in 2019. The meeting occurs once every two months delivered in-person and virtually. Attendees are multidisciplinary: medical and nursing staff from various paediatrics, anaesthetics, ODPs and emergency settings. The structure of each meeting covers two cases, with a 10-minute presentation and a 15-minute discussion per case. Discussion aims to reflect on good practice, lessons learned and action points. It also serves as an additional debrief for those involved. A high-impact learning summary is produced, as shown in figure 1, shared and saved securely. Feedback is collected after each session. Results There has been a meeting every 2 months since November 2019 with an average of 30 multidisciplinary attendees. Good practice points included: early escalation to CATS, closed-loop communication within the multi-disciplinary team, frequent updates for the child's parents, and using set checklists for complex procedures and calculations. Recurring themes for learning points fall in to 4 categories: Human factors – structured SBAR handovers, awareness of prescription errors. Teaching – teaching sessions, public health measures such as vaccine promotion. Practical learning – ventilator settings, sedation for intubation, escalation to seniors. Environmental factors – availability of resources (e.g. urine toxicology screen) in other hospital areas, using a quiet space for procedures like intubation. Example action points include: arranging simulation sessions for management of difficult airways, ensuring theatres have necessary equipment for emergency front-of- neck access in a child of any age, completing Datix forms after a meeting discussion highlighted a clinical incident that required formal review. Feedback demonstrated sessions were enjoyable, useful for learning and well received. Conclusion Children requiring emergency transport is one of the most high-risk, stressful and logistically complex events we are involved in. Our regular ROAR meetings have addressed many aspects of high-quality care simultaneously: governance; continuing professional development; multidisciplinary working; and staff wellbeing. These meetings also enabled us, as paediatricians, to reflect jointly with our anaesthetic colleagues. We suggest that all district general hospitals could benefit from running such meetings with the ultimate aim of improving the lives of children, families and staff.