6088 The RBHSC symptom checker: a QI initiative utilising QR codes posters and a symptom checker website to improve access to paediatric discharge advice

Objectives 'Safety netting' at Paediatric discharge is a safety measure which aims to educate parents on ongoing homecare and when to return if deterioration occurs. Optimal advice is specific, reinforced in writing and should be documented.1 Clinicians reported limited time to source high quality written safety-netting advice. Safety netting practice in the Royal Belfast Hospital for Sick Children (RBHSC) is previously unstudied. This project aimed to collect baseline data on current safety netting advice given to parents at discharge from general paediatrics in a tertiary hospital and improve the quality of advice, as well as an increase in documentation of advice shared, through novel QR code posters placed throughout clinical areas as well as clinician education. Methods The Belfast Trust's innovative Children's Symptom Checker website, produced using national partners Alder Hey and Healthier Together, hosts trustworthy medical advice for parents. We commissioned novel QR code posters linking to the website as a source of accessible written discharge information for parents. Over 11 weeks (W1–11), random weekly chart audit of patients discharged from RBHSC Medical Paediatrics (n=92) recorded whether verbal/written discharge advice was documented. W1–3 served as baseline (n=30) pre-intervention. A teaching session on how to safety-net parents and carers was incorporated into the departmental teaching at week 4 and repeated on week 9 (as not all staff able to attend). QR code posters were placed in clinical areas at week 8. Results Baseline (W1–3) verbal advice was documented in 40% of discharges and written advice in none. Post-initial teaching (W4–7) verbal advice rose to 63.3%; and written to 13.3%. Immediately after poster introduction (W8), verbal advice peaked at 100% and written 42.9%. Following repeat teaching (W9–11), verbal advice was 64%, and written 40%. On a run chart, all verbal data-points remained above the baseline median from W4, as shown on graph 1 and all written data-points from W6, as shown on graph 2. Conclusion As a result of the introduction of QR code posters to RBHSC and repeated clinician education, a sustained improvement in safety net practice was demonstrated. Ensuring parents and carers are appropriately signposted with deterioration advice is increasingly important as unscheduled workload in paediatrics is ever increasing. Further research is needed into the care-giver's understanding and experience of accessing online safety-netting advice. Reference Roland D, Jones C, Neill S, et al. Safety netting in healthcare settings: what it means, and for whom? Archives of Disease in Childhood – Education and Practice 2014;99:48–53.