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Displaying One Session

Short oral session
Session Type
Short oral session
Room
Hall E
Date
18.10.2020, Sunday
Session Time
11:10 - 12:10
Session Description
Pre recorded & Live Q&A

TIME SAVING PACKS

Session Type
Short oral session
Date
18.10.2020, Sunday
Session Time
11:10 - 12:10
Room
Hall E
Lecture Time
11:10 - 11:15

Abstract

Abstract Body

Intravenous Cannulation (IVC) is a common task for all junior doctors during day/night of the shifts. It is often time consuming to prepare the equipments needed to prepare for the task.

Aim

To reduce the time of preparation by creating IVC packs

To see an improvement of time efficiency in IVC process

To make IVC insertion a better experience for junior doctor

Methods

We completed this study using PDSA cycles.

We surveyed doctors and PNPs from multiple different departments to find out about their experience of cannulating on the different wards and we addressed the issues .

Result

Our initial survey of 23 suggested that IVC takes more than 20 mins with most doctors expressing spending half fo the time preparing equipments. We reorganised the treatment rooms which we found it challenging to sustain.

We surveyed and prepared IVC packs and put these packs in the treatment rooms, doctors office and PNP office on mountain ward.

Pre IVC packs showed 30% of doctors/PNPs said IVC preparation takes 0-2 mins, 25% stated 2-5 mins and 45%t stated it is > 5 mins. Post IVC packs >80% of doctors/PNPs stated IVC preparation takes 0-2 mins. The found the packs to be handy and time saving.

Discussion/ Conclusion

IVC packs are indeed handy and useful. Our ultimate aim is to extend IVC packs to all department and resus trolleys in the Evelina. We are currently working out the costing and branding to carry this forward.

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PAEDIATRIC PROMOTION AND INTERVIEW WORKSHOP DAY: AN INITIATIVE TO INSPIRE DOCTORS TO CHOOSE PAEDIATRIC TRAINING, CHOOSE THE WEST MIDLANDS AND PREPARE THEM FOR INTERVIEW

Session Type
Short oral session
Date
18.10.2020, Sunday
Session Time
11:10 - 12:10
Room
Hall E
Lecture Time
11:15 - 11:20

Abstract

Abstract Body

Background and Aims

Since 2016, there has been a progressive drop in applications and trainee fill rates for paediatric training, as reported by the Royal College of Paediatrics and Child Health (1).

We developed a Paediatric Promotion (PP) & Interview Workshop day with the aim to inspire trainees to apply to paediatrics, apply to the West Midlands, and to prepare them for specialty interviews.

Methods

The PP day was facilitated by trainees and consultants. The morning had interactive sessions: ‘Why Paediatrics,’ application & recruitment process, region-specific opportunities, including out of program experiences, sub-speciality, leadership, and research opportunities.

The afternoon encompassed small-group interview workshops including a Portfolio station demonstrating successful portfolios. Post-event a mixed quantitative and qualitative survey was used to assess whether aims were met.

Results

The day was facilitated by 18 trainees and consultants and attended by 16 foundation doctors. The post-event survey was completed by 14 attendees. 71% rated the day as ‘excellent’ and 29% as ‘very good’. The attendees most valued interview workshops and the opportunity to view successful portfolios. Candidates were keen for further interview practice and requested further ‘example answers’ to interview questions. 92% of those eligible to apply reported they would be applying to paediatrics and 100% reported the day influenced their decision to apply to the West Midlands.

Conclusions

The PP initiative provided the opportunity for attendees to get “more excited about applying to paediatrics,” “consider the West Midlands,” and “feel more confident in applying.”

Reference

(1) https://www.rcpch.ac.uk/sites/default/files/2018-03/2015_rcpch_state_of_child_health_the_paediatric_workforce_v1.1.pdf

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PROJECT TO REDUCE WAITING TIME AT MEDICAL INSTITUTIONS USING AN AUTOMATED HISTORY TAKING SYSTEM IN A PEDIATRIC OUTPATIENT DEPARTMENT AT A CLINIC

Session Type
Short oral session
Date
18.10.2020, Sunday
Session Time
11:10 - 12:10
Room
Hall E
Lecture Time
11:20 - 11:25

Abstract

Abstract Body

Background: Gathering patient medical history system has been developed, and attempts are being made to introduce a system for monitoring patients’ condition and optimize waiting time according to patient status to prevent worsening of severity. Paediatric outpatients are answered by caregivers while caring for unwell children, but there are no reports on factors that affect the answer time of the systems.

Objective: To evaluate the answer time and the influencing factors of an automated history taking system at a paediatric outpatient clinic.

Methods: We conducted a prospective cohort study at an educational family medicine clinic introduced the system between August 2018 to April 2019. The subjects were 1800 children under 18 years of age using the system (mean age, 5.3 (standard deviation 3.8) years old; girls, 46.4%). The elapsed duration from when the patient or guardian received a tablet terminal to the completion of the input items was measured as the answer duration using the log data. The primary outcome was the answer duration in each respondent category.

Results: The median and the 95 percentiles answer duration was 264 and 585 seconds, respectively. The duration was significantly related to sex, a number of responding symptoms, past use count of the system, and patient age group. For respondents, the duration by grandparent group was significantly longer than the mother group but was not significant for the others.

Almost all of the pediatric patients could complete their responses in six minutes using this system, which was also available to the elderly.

fig1.jpg

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USING COVID TO RAPIDLY IMPROVE ACCESS TO SPECIALIST PAEDIATRIC ADVICE FOR PRIMARY CARE IN AN EMERGING INTEGRATED HEALTH CARE SYSTEM

Session Type
Short oral session
Date
18.10.2020, Sunday
Session Time
11:10 - 12:10
Room
Hall E
Lecture Time
11:25 - 11:30

Abstract

Abstract Body

Background and aims

At the start of the pandemic, we sought to protect child health and support colleagues by improving existing communication methods between secondary and primary care in responding to emerging COVID and non-COVID health problems. Good evidence exists for safe email and telephone advice.

Methods

Interventions:

1. Email advice with 48-hour response time

2. Mobile phone line manned 8.30am-5.30pm Monday to Friday

3. Direct phone line to the Emergency Department (ED) for urgent queries and referrals

4. Video consultation between patient and paediatrician

5. Optional face to face (F2F) outpatient contact for those deemed necessary

The service was staffed by a rota of senior paediatric trainees with consultant supervision

Results

During a 24-day period at the peak of the COVID pandemic, the service received a total of 95 contacts with the service; 68 telephone calls, and 27 emails. 26% required urgent attendance in ED, 16% had F2F paediatric review, 38% could be dealt with remotely via phone, email or video (figure 1). Feedback was overwhelmingly positive, from both primary care and trainees.

Conclusions

One quarter of referred cases needed to be seen urgently. Teleconsultation was used in one in six cases. This service strengthened links between primary and secondary care and provided a valued training opportunity during a challenging era. Post COVID, we intend to retain the interventions and go on to formally evaluate patient, specialist, trainee and primary care satisfaction, and whether the interventions reduce the number of children who present with advanced or untreated disease.

gp line up to 27 apr sankey.png

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UNINTENTIONAL CANNABIS INTOXICATION IN CHILDREN: A 10-YEAR ITALIAN TERTIARY PAEDIATRIC HOSPITAL EXPERIENCE

Session Type
Short oral session
Date
18.10.2020, Sunday
Session Time
11:10 - 12:10
Room
Hall E
Lecture Time
11:30 - 11:35

Abstract

Abstract Body

Background: In Italy, drugs consumption is illegal, including cannabis. The health impact of unintentional intoxication in paediatrics is under-documented. We evaluated the cannabis intoxication trend in children in a tertiary paediatric hospital over a 10-year period, and described epidemiological and clinical characteristics of our cohort. Methods: A retrospective study was performed, including children aged < 4 years admitted for cannabis intoxication during the study-period. Cannabis intoxication was diagnosed as for compatible symptoms and positive urine toxicological screening. Results: Seven children were included (4 females). Annual admission increased over time: no cannabis intoxications were reported before 2017, 4 intoxications were reported in 2018 and 2 in 2019. Mean age was 22 months (range 11-47 months); the oldest was a child with development retardation. As for ethnicity, 4 children were Italian, 2 Serbian and 1 Kosovan. All cannabis intoxications were unintentional, reported to happen in public gardens in 5 cases, at home in one case and in a nomad camp in another. Most (5 cases) were lethargic with respiratory depression in 2 of them; other 2 had seizures. Two children required intensive care admission and invasive ventilation, whereas 5 were admitted to general paediatric ward. Four children did not require treatment; only one underwent gastric lavage and mannitol therapy. Conclusions: Unintentional cannabis intoxication has demonstrated to be an increasing problem over time. Common presentations include acute intoxication but severe symptoms are also reported requiring intensive care. Clinical vigilance is needed to suspect and diagnose cannabis exposure in the ED or paediatric ward.

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EVERYDAY LEADERSHIP IN JUNIOR DOCTORS

Session Type
Short oral session
Date
18.10.2020, Sunday
Session Time
11:10 - 12:10
Room
Hall E
Lecture Time
11:35 - 11:40

Abstract

Abstract Body

Background and Aim: Leadership in Medicine is vital for safe patient care and important at every tier of training. In order to provide high qualty care, it is paramount to initiate the awareness and importance of everyday clinical leadership early in training.

Methods: We undertook a questionnaire survey of junior doctors working in a District General Hospital in UK. We asked them to rate their skills in leadership, clinical decision making, leadership qualities they deem to be important, perceived obstacles to shared decision making, ability to provide a safe environment, evidence-based decisions, ability to actively identify a problem and solve them, teamwork, valuing other team members, interpersonal skills, identifying personal goals, interest in quality improvements and enabling attitude to developing a team.

Result: The responses demonstrated that junior doctors rated their leadership skills as low but clinical decision-making skills as high. Majority of the junior doctors identfied the following characteristics as important for leadership: effective communication, prioritisation, decision-making, empathy, trust and hard work. They identified heirarchy as an obstacle and others identified work pressures, lack of experience, lack of opportunities to lead and fatigue as other causes.

Conclusion: Our survey revealed a gap in knowledge of how to establish and identify clinical leadership in everyday cinical practice. We have initiated a rolling programme of monthly leadership prompts encouraging the trainee to reflect on daily leadership opportunities and thus hone awareness of their innate leadership skill, enable the trainees and help promote a safer and empowered work culture.

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ACADEMIC CHILD SEXUAL ABUSE CLINIC IN THE NETHERLANDS

Session Type
Short oral session
Date
18.10.2020, Sunday
Session Time
11:10 - 12:10
Room
Hall E
Lecture Time
11:40 - 11:45

Abstract

Abstract Body

Background/aims: Evaluating children with suspected sexual child abuse remains challenging for clinicians, especially when a clear narrative of sexual abuse is absent. We provide an overview of children referred for suspected sexual abuse to our academic child abuse team.

Methods: Children presenting to our child abuse team in 2019 were recorded in a database. Acute cases ((suspected) sexual abuse within 7 days) were evaluated at the emergency department with outpatient clinic follow-up. Non-acute cases were checked in our outpatient clinic. Patients were evaluated for somatic and psychological signs of sexual abuse, and risk factors for abuse. When applicable, supportive counseling was initiated. By expert opinion of the team, concerns for sexual abuse were either confirmed or not.

Results: 127 children and adolescents were evaluated. Of the 42 acute cases, forensic examination was performed in 60%, 43% received additional medical treatment (e.g. post-exposure prophylaxis) and 3 children (6 years old and 2 adolescents) were diagnosed with a sexual transmitted disease (STD). Of the 85 non-acute cases, 2 children (4 and 8 years old) were diagnosed with a STD. Risk factors for child abuse were identified in 89% (113/127) of all cases. Children with confirmed concerns for sexual abuse (43%) were older compared to non-confirmed cases (mean 9.7 vs. 7.0, p=0.001). 63 children (50%) at risk for PTSD were referred for psychotherapy.

Conclusions: Medical examination for STD is necessary even in young children, concerns for sexual abuse are more often confirmed in older children, and half of the cases need trauma-related psychotherapy.

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