Study to evaluate paediatric Accident and Emergency services within England and Wales

This Study aimed to describe paediatric Accident and Emergency (A&E) care within England and Wales, identify barriers to providing a service which complies with guidelines and to recommend action to improve child centred A&E care within the West Midland’s A&E departments. A questionnaire built upon interview data and previous studies was posted to senior nurses and consultants in the 247 A&E departments in England and Wales. Replies were received from 232 of these departments. A survey of training was incorporated in the main questionnaire and was also sent to every registered nurse working in A&E departments in the West Midlands, 98% of those nurses replied. Face to Face interviews took place with 88% A&E consultants and 70% senior nurses in A&E departments in a West Midlands interview sample. Follow up telephone interviews with every department interviewed were used to check conclusions, confirm earlier data and identify developments in the West Midlands departments. The results describe a comprehensive picture of A&E paediatric services in England and Wales. 72% departments state children are 29% of their attendees, 47% do not have a Registered Sick Children’s Nurse (RSCN) on their staff, and 45% departments are not visited by a paediatric consultant. There is no common system of assessment and prioritisation for children, 52% departments use triage systems for assessment which do not incorporate psycho-social and developmental needs, 41% departments do not keep separate records for paediatric attendees and 24% are unable to identify repeated attendees. A comparison of consultant replies with an earlier study by BPAS in 1985 shows encouraging improvements over ten years, a three fold increase in paediatric waiting room provision, threefold increase in paediatric treatment room provision and a 35% increase in RSCNs in A&E departments, yet there is a significant decrease in the number of departments able to retrieve previous attendance data. Training questionnaire comparison of A&E nurses in the West Midlands with those in the rest of England and Wales shows the West Midlands has significantly lower training in all aspects of paediatric A&E care, for example, Child Protection training is 52% greater outside the West Midlands and 26% A&E nurses in the West Midlands have received Advanced Life Support training as opposed to 68% in the rest of England and Wales. Barriers and Constraints to service provision are identified as: staff recruitment, loss of on-site paediatric support, difficulty in assessment of priority for children in a mixed adult/child workload and the availability of training. West Midlands developments identify an increase in RSCNs in A&E to 42% departments and a decrease of on-site paediatric units. Common issues for all A&E departments were identified as, availability of appropriately trained staff, availability of training for existing staff, no common form of audit and monitoring system and inconsistent communication networks. Recommendations are focused on improving service provision in West Midland A&E departments