Rapid Response improves care for our sickest children

More children are now being treated in their own homes without the need to be admitted to Nottingham University Hospitals NHS Trust (NUH) when they develop breathing and other respiratory problems.

A physiotherapist responds to calls from families of children with severe disability, life limiting and life threatening conditions – who may spend several weeks in hospital each winter with prolonged chest infections. The ‘out-reach’ service allows experts to treat the children quickly and effectively at home.

Parents and families have also been trained in chest clearance techniques to prevent infection in these fragile children. Those who are admitted to the Children’s Hospital at NUH now have additional support to return home as quickly as possible.

The ‘Rapid Response’ Respiratory Physiotherapy programme was set up as a pilot by Moira Flanigan, children’s physiotherapist at NUH, and Dr Toni Wolff, disability paediatrician, with the support of Dr David Thomas, respiratory paediatrician. Families have reported improved confidence and a significant improvement in the quality of their family life.

Moira Flanigan said: “There are increasing numbers of children with complex disabilities living longer in the community.
“The most common cause for any child to be admitted to hospital is with a respiratory infection. Children with disability are even more prone to respiratory infections and it’s much harder for them to recover. Many have life threatening chest infections and will die in childhood, so it’s even more important for their quality of life and that of their families to keep them out of hospital. Once in hospital, care often escalates so that these children end up in an intensive care unit.

“We can give these disabled children antibiotics and chest physio at home promptly and therefore prevent the need for admission, or if they are admitted to get them home sooner.”

The project has involved 30 children with severe disability and long term conditions who have frequent hospital admissions for respiratory illness. Each child has an individual respiratory emergency care plan.

During the pilot, it has been found that effective respiratory secretion clearance has prevented and shortened the duration of chest infections in this group – and has reduced hospital admissions.

As well as improved care, the service has saved a considerable amount of money and prevented more than 80 Emergency Department attendances and hospital admissions in a nine-month period.

Moira Flanigan added: “Since this service started I have trained over a 100 professional carers of disabled children as well as family members to deliver regular chest clearance, which helps to keep these children well and out of hospital.
“Most of my children have communication difficulties but those children who can let me know emphasise how important it is to them to stay out of hospital and have treatment from a familiar person when they are unwell.”

The Rapid Response project was successful at the recent 2011 Health Service Journal Awards – scooping first prize in the Clinical Support Services category and being named runner up in the category of Acute Service Redesign.

Dr Toni Wolff said: “This is a fantastic service which provides high quality care closer to home. By working collaboratively in the community we are keeping children out of hospital and improving the quality of their lives and those of their families. We also have data to show that we are saving the health service a lot of money by preventing admissions and getting children with disabilities home from hospital more quickly.”

Funding so far has been through the Department of Health and the local primary care trust, which is secured until March 2012, with a view to making it a permanent service.