6167 Pre-alert outcomes for paediatric patients (POP) in two birmingham district general hospitals

Objectives The ambulance pre-alert system is designed to enable efficient and effective activation of the required clinical pathway by receiving clinicians.¹ However, when used inappropriately patient safety concerns arise, as clinicians are pulled from critically unwell patients.² This service evaluation aims to assess if pre-alerts appropriately identify unwell children requiring immediate intervention. Methods This is a retrospective analysis of data from two district general hospitals in Birmingham between February – April 2023. Data was extracted from online notes for all paediatric (0–16 years) ambulance presentations and screened for pre-alerts. All pre-alerted patients within this period were included. Results In total, 1429 patients presented by ambulance in the 3-month period. 168 patients were pre-alerted. Of these, 88 (52.4%) were discharged on the same day, 15 (8.92%) required HDU admission, and 3 from this cohort were transferred to PICU, 2 (1.19%) were transferred to PICU directly from ED, 2 (1.19%) were deceased on arrival, and 3 (1.79%) did not have a documented date of discharge. The median duration of admission was less than one day (IQR 1). The distribution of length of stay shows that most children are suitable for prompt discharge, but there is a tail of children with longer stays. A Paediatric Early Warning Score (PEWS) of ≥4 on presentation showed a sensitivity of 71.2% and specificity of 59.7% for admission, with a positive predictive value of 62.0%. The median number of clinicians per alert was two (IQR 1), despite the local guidance requiring attendance of at least one ED clinician, senior paediatrician, and senior ITU doctor. However, unclear documentation impacts the accuracy of this. Only 86 patients (51.1%) had documented ambulance handovers, and only 63 patients (37.5%) had relevant clinical pathway paperwork. Conclusion The relatively high proportion of children requiring HDU suggests that pre-alerts are sensitive to identifying unwell children. However, as the majority of children are discharged on the same day, it is evident that the system requires reshaping to improve specificity and reduce the number of unnecessary alerts. Fatigue from inappropriate pre-alerts may contribute to suboptimal clinician attendance and documentation, which needs to be addressed locally. Moreover, many paramedics express concerns about limited experience in assessing sick children,³ highlighting the need for additional tools or education. To this end, the pre-existing PEWS may have a role in the pre-hospital setting, as demonstrated above.³ ⁴ Further research is needed to explore this. References Clinical Notice: Pre-alerting of Patients. West Midlands Ambulance Service, 2021. Sampson, et al. Pre-alerts study: Exploring the use of pre-hospital pre-alerts and their impact on patients, ambulance service and Emergency Department staff. 2022. Implementing a paediatric early warning score into pre-hospital practice. Rolls, 2019. Corfield, et al. Paediatric early warning scores are predictors of adverse outcome in the pre-hospital setting: a national cohort study. 2018.