6354 Open access (OA) for children in oxfordshire using local OA-team support: can PDSA interventions improve the experience for parents and staff?

Objectives Providing remote advice adjusts patterns of paediatric referrals and reduces ED attendances.¹ ²Open Access (OA) telephone advice from our local hospital has been provided for 15 years (2008–2023) to support parents of children with chronic conditions (Long-Term-OA, 24/7) and those with acute conditions (Short-Term-OA, 24h- several days), permitting early discharge with Local-OA-Team-Support (LOATS). With added pressures of staffing and complex tasks, we sought to improve local access call-facility for parents, reduce nursing workload and ensure a safe clinical journey. Methods Phone-call interactions and satisfaction surveys were tested. Two three-month audit cycles were determined using PDSA framework of 'Plan, Do, Study, Act' before and after interventions: a dedicated mobile phone number, Triage flow assessment [TF], and a detailed call-proforma. Three surveys were sent to parents and staff during each cycle before and after interventions. Results A total of 163 calls were reviewed (132 all-calls February-April; 31 OA-calls August-October). A total of 111 user-surveys (51 Staff, 60 parents) were conducted during winter-summer seasons 2022–2023. Call audit Pre-intervention Of 132 all-calls, the majority were non-OA (83, 63%) and one-third were OA (48, 36%). Duration: median 5mins (range 1–30mins). Outcomes: Half achieved resolution with advice (70 calls, 53%); 20 patients required re-admission (15%); other reasons/administrative tasks (27 calls, 20%). EPR call-documentation: 0%. Call audit Post-intervention Of 31 calls, majority OA-calls (28, 90.4%) used dedicated mobile number. Duration: median 5.75 mins (range 1–30mins). Outcomes: [figure 1]. EPR call-documentation dramatically improved: 80%. Surveys Three surveys were conducted [figure 2]. The parents' survey (60 responses) confirmed two-thirds respondents (36, 60%) used OA-facility; their preferred communication mode was direct-line to ward phone (33, 55%), although parents supported additional virtual options (mobile or email). Staff surveys suggests no seasonal impact on call-activity (>5 calls/respondent: winter 47% vs summer 44%) but post-intervention-survey attitudes improved towards EPR documentation; furthermore 63.4% would recommend Local-OA-Team-Support for other Trusts. Conclusion When testing through PDSA cycles, the Local-OA-Team-Support (LOATS) offers an efficient and viable safety-net for children deemed safe for discharge and is greatly valued by parents. This prevents readmission in the majority (65%) and offers a local service that resolves the problem speedily. Our interventions supported appropriate escalation via the TF, re-distributed staff workload and met 'Safety and Governance' requirements with EPR documentation. Team communication was achieved by call- equity, enhanced by data-gathering and governance meetings, so empowered staff to manage communications efficiently. Over 60% staff would recommend Local-OA- Team-Support for other Trusts. References Alviani C, Doran A, Hands C, et al. G195(P) Development of a paediatric telephone advice service for general practitioners in a district general hospital setting Archives of Disease in Childhood, 2016;101:A104. Egan M, Murar F, Lawrence J, et al. Identifying the predictors of avoidable emergency department attendance after contact with the NHS 111 phone service: analysis of 16.6 million calls to 111 in England in 2015–2017. BMJ Open, 2020;10:e032043. doi:10.1136/bmjopen-2019-032043. Glossary ED Emergency Department EPR Electronic patient record LOATS Local Open-Access Team Support OA Open-Access TF Triage Flow Assessment