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Substituting community children's nursing services for inpatient care: a case study of costs and effects
  1. Peter Callery1,
  2. Richard G Kyle2,
  3. Helen Weatherly3,
  4. Michele Banks1,
  5. Carol Ewing4,
  6. Peter Powell5,
  7. Susan Kirk1
  1. 1School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
  2. 2School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK
  3. 3Centre for Health Economics, University of York, York, UK
  4. 4Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  5. 5Paediatric Department, West Suffolk Hospital, Bury St Edmunds, Suffolk, UK
  1. *Correspondence to
    Dr Peter Callery, School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK; peter.callery{at}manchester.ac.uk

Abstract

Objective To compare children's pathways to and through Community Children's Nursing Team (CCNT) care, and NHS costs, before and after relocation of inpatient services and extension of a paediatric Emergency Department and Observation and Assessment Unit (ED/OAU).

Design Case study. Routinely collected data on activity and staffing were provided by the CCNT. Parents completed questionnaires about their child's use of healthcare services and satisfaction with care preservice reconfiguration (n=221) or postreconfiguration (n=210). The cost of service use was compared prereconfiguration and postreconfiguration.

Patients Children referred to CCNT care.

Main outcome measures Healthcare service use and associated costs, satisfaction with CCNT care.

Results The mean number of services used before referral to the CCNT reduced from 2.8 to 1.6, and the proportion using only one service increased from 26% (n=58) to 61% (n=128). Inpatient admission during CCNT care reduced from 6% (n=13) to 2% (n=4), and ED attendance from 37% (n=79) to 16% (n=31). There was a considerable fall (25%) in the cost of CCNT care, and a sharp fall (55%) in the average overall NHS cost of care. CCNT care was rated ‘excellent’ or ‘very good’ by 85% of respondents both prereconfiguration and postreconfiguration.

Conclusions A CCNT provided an alternative to hospitalisation when acute general paediatric services were reconfigured to substitute for a relocated hospital. Children's pathways to CCNT care were shortened. The average cost of CCNT care and overall NHS cost were lower following reconfiguration. Satisfaction remained high throughout.

  • nursing
  • paediatrics

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