Greater than 50% of children admitted to paediatric units have one of six high-volume conditions. Most remain in hospital for less than one day. HANDi Paediatric App provides parents and medical professionals with fully integrated care pathways through home, primary care and into hospital for each of the high-volume conditions. It empowers healthcare professionals with evidence-based guidance and families with accessible, high-quality health information and locality specific signposting.
Our greatest achievements are the number of unique users through our own region, positive feedback from parents/carers and professionals, reduced total admissions for the 6 high-volume conditions and the successful reskinning of HANDi Paediatric for other regions.
Challenges
• 60% of our local paediatric admissions were children with one of six high-volume conditions. The majority (56%) of these admissions lasted less than one day (zero day length of stay) with a cost to our unit of £402,000 per annum (based on 2012/13 data).
Six high volume conditions:
1.Gastroenteritis
2.Asthma/wheeze
3.Bronchiolitis
4.Mild febrile illnesses
5.Abdominal pain
6.Common newborn problems
These common childhood conditions predominate in the 0-3 years age bracket due to children’s physiological and immunological immaturities at this stage of their development. This age group are more difficult for non-specialists to assess and there is a wide variation of experience in the prehospital setting. We believe that many of these visits to secondary care are preventable acute admissions and by empowering parents/carers and primary care teams we may be able to manage these children just as successfully closer to home.
• High quality care pathways already existed for some of these conditions. These included integrated care pathways for home, primary and secondary care. However these pathways were little known about and instead multiple alternative versions of guidelines existed in different clinical settings. The challenge was how to make the existing integrated care pathways and newly developed pathways available to all within the system.
Our primary aim was to provide families with consistent evidenced-based support and information whether they be at home, at their GP surgery or seeing our junior doctors in the emergency department or on the childrens unit. A one stop solution for parents/carers and primary and secondary care healthcare professionals.
• Across these healthcare setting no single IT device or program existed to communicate our pathways to all. We therefore set out to develop our own.
Actions
• Information technology solutions are numerous and we set out to find a method that provided secure, robust and safe technical programming whilst delivering an accessible and user-friendly interface. This led us to the use of smart phone technology with 70% of people aged 12-54 being smartphone users in the UK in 2015. Website reliance on Wifi on 4G acess was not ideal whereas a downloadable application provided an opportunity to deliver information wherever and whenever it was needed. We also felt it gave us control over the quality of information provided and the ability to update material as new research and national guidance were published.
• We successfully competed for non-recurring funding application from the South West Strategic Clinical Network (NHS England) to develop innovative strategies to avoid unplanned admissions for children and young people. We were awarded £50,000 to take the project through to local completion over a one-year time frame. This funding enabled us to commission an IT development company to build the app in partnership with our clinicians, legal support to ensure the app was built with the correct liabilities in place and adequate funding for advertising the app on its release.
• We devised comprehensive integrated care pathways for all six of the common high-volume conditions based where possible on national guidance. Where national guidance was not available the highest level of evidence available was used. These pathways were then reformulated into algorithms and information pages suitable for an app format.
• Outcome tools were devised to provide qualitative data on app usage (through an inbuilt analytic program within the app), data dashboard to monitor admissions figures for the 6 high-volume conditions and qualitative feedback from our stakeholders.
• We have subsequently been able to successfully develop our app for other regions in the UK and developed new reskinned versions of HANDi Paediatric in use across the South West of England.
Results
From the beginning we were unable to facilitate a prospective controlled study due to funding pressures, therefore 3 outcomes measures were chosen:
1. Quantitative data from inbuilt analytic programe as a measure of
(i) usage
(ii) retention and
(iii) growth:
Outcomes (up to end October 2016) for Taunton version of HANDi Paediatric:
(i) Total unique user events – 7937 (69% parents/carers; 14% community healthcare professionals & 17% Hospital users)
(ii) 16% of users revisit the app within 1 month Average number of sessions per user 2.5
Outcomes for all versions of HANDi Paediatric (up to end October 2016):
(i) Total number of unique users – 14,616 Total number of unique user events – 60,615
(ii) Users who revisit the app within 1 month of download – 16% Medium session length 45 seconds
(iii) Average weekly growth in users (October 2016) – 20% android users and 5% iOS users.
2. Paediatric admissions dashboard to monitor admissions for the 6 high-volume conditions by using ICD10 codes from discharge summaries. Key data is presentated in its raw form on data dashboard (Figure 1) and as percentage change in hospital admission for the 6 high-volume conditions comparing 12 months before to 12 months after HANDi Paediatric release (Figure 2). It is important to note that at the time of release of HANDi Paediatric at MPH paediatric departmental strategy was focused on reducing unscheduled admissions.
Other tests of change were taking place, therefore statistics need to be interpreted with caution and improvements in admission data are likely to multifactorial.
Outcomes: 15% reduction in total admssions for children with 6 high-volume conditions (Figure 2). Key reductions were in fever and minor infection, abdominal pain and newborn problems. Increased admission rates were seen with bronchiolitis and gastroeneteritis.
3. Qualitative feedback was sought in the development stage from medical professional colleaugues within departmental meetings and at the time of release from our stakeholders. Qualitative feedback from parent/carers is summarised using direct quotes in document attached below. A clear decision was made on creating the app that user identifying data would not be collected as it was felt this would deter some people from downloading the app.
Value
-HANDi Paediatric was delivered on time and in budget.
-Reduing unscheduled admissions: In the year following HANDi Paediatric release we saw a 15% reduction in admssions for the 6 common conditions (this can not be attributed solely to the app). Extrapolated to financial savings, assuming 1 bed/day per admission, the result is a saving of £190,840 and 367 bed/days year ending August 2015 compared to the year ending August 2014.
-As a commercial project roll-out of HANDi Paediatric began in 2015. It is purchased by CCGs for each of their paediatric units and includes a yearly subscription for 5 years. HANDi Paediatric has proved to be a profit making innovation (Figure 3: year 1 and 2 finacial statement). Currently 5 acute trusts are using the app and a further 2 CCGS have commsioned new versions.
In detail
AMBITION
Greater than 50% of children presenting acutely to paediatric departments across the UK (1) and 60% locally at Musgove Park Hospital (MPH) (2) have one of six high-volume conditions. 56% these children remain in hospital for less than one day The six high-volume conditions at MPH are: 1.Gastroenteritis 2.Asthma/Wheezy child 3.Bronchiolitis 4.Mild febrile illness 5.Abdominal pain 6.Common newborn problems
High quality evidence-based pathways were in existence to assist parents, primary care healthcare professionals and secondary care doctors to assess and manage children with some of these conditions. At each stage (parent, primary care and secondary care) they signpost towards appropriate escalation of care and provide consistent guidance through the whole system. Despite the work put into their development, these pathways were generally unknown by families and any part of the health system. Our challenge was to find an effective method of reaching parents/carers and professionals across the whole patient pathway – a whole systems approach that was visible to all people in the system whenever and wherever they needed it.
Smartphones are used extensively by the UK population. It was projected that by 2015 70% of people in the UK would have mobile phones, the vast majority would be smartphone users (3). This provided an exciting opportunity to assist our population in accessing evidence-based advice and support wherever they are located. Both mobile websites and smartphone applications were considered. Due to our rural location we were clear that the pathways needed to be reliably accessible without 4G or WiFi connection. Smartphone applications became the obvious choice. .
Specifically: Our Application was designed to enable parents/carers/young people to:
- access fast answers wherever they are
- find an appropriate range of options for onward care and appropriate escalation for red-flag symptoms
- access high quality evidence-based information for their medical problem.
- use technology they can relate providing a valuable interactive experience.
For our NHS network it:
- allows non-urgent patients the opportunity to access self-care pathways
- is designed to free up valuable primary and secondary care resource
- ensures a consistent and co-ordinated approach across the whole system
- is hoped to reduce the costs of unscheduled care across primary and secondary care
- allows local NHS advice to prevail over ‘chat room’ advice
OUTCOMES:
From the beginning we were unable to facilitate a prospective controlled study due to funding pressures, therefore 3 outcomes measures were chosen:
1. Quantitative data from inbuilt analytic programe as a measure of
(i) usage
(ii) retention and
(iii) growth:
Outcomes (up to end October 2016) for Taunton version of HANDi Paediatric:
(i) Total unique user events – 7937 (69% parents/carers; 14% community healthcare professionals & 17% -Hospital users)
(ii) 16% of users revisit the app within 1 month Average number of sessions per user 2.5
Outcomes for all versions of HANDi Paediatric (up to end October 2016):
(i) Total number of unique users – 14,616 Total number of unique user events – 60,615
(ii) Users who revisit the app within 1 month of download – 16% Medium session length 45 seconds
(iii) Average weekly growth in users (October 2016) – 20% android users and 5% iOS users.
2. Paediatric admissions dashboard to monitor number of admissions for the 6 high-volume conditions Key data is presentated in its raw form on data dashboard (Figure 1) and as percentage change in hospital admission for the 6 conditions comparing 12 months before to 12 months after HANDi Paediatric release (Figure 2). It is important to note that at the time of release of HANDi Paediatric at MPH our departmental strategy was focused on reducing unscheduled admissions.
Other tests of change were taking place, therefore statistics need to be interpreted with caution. Improvements in admission data is likely to be multifactorial.
Outcomes: Figure 2: -15% reduction in total admssions for children with 6 high-volume conditions - Key reductions were in fever and minor infection (35% reduction), abdominal pain (5% reduction) and newborn problems (1% reduction).
3. Qualitative feedback was sought in the development stage from medical professional colleaugues within departmental meetings and at the time of release from our stakeholders. Qualitative feedback from parent/carers is summarised using direct quotes in document attached below.
PROOF OF SCALABILITY
HANDi Paediatric has proved locally to be an efficient method of making self care pathways and quality professional guidelines available to the whole system. Free at the point of download to all users it offers specialist advice from local paediatricians and avoids the need for in-app advertising or payments. HANDi Paediatric has subsequently been rolled-out to other paediatric providers.To date it is in use in 5 Acute Paediatric Units across 3 CCGs. It is being built for two further CCGs at the time of writing. HANDi Paediatric is now a profit making NHS innovation.
VALUE
HANDi Paediatric was delivered on time and in budget. It’s value can be measured in a number of ways. For our clinical team the value of HANDi includes empowering self-care in line with national healthcare strategy. Reduing unscheduled admissions: In the year following HANDi Paediatric release we saw a 15% reduction in admssions for the 6 common conditions (this can not be attributed solely to the app).
Extrapolated to financial savings, assuming 1 bed/day per admission, the result is a saving of £190,840 and 367 bed/days year ending August 2015 compared to the year ending August 2014. As a commercial project roll-out of HANDi Paediatric began in 2015. It is purchased by CCGs for each of their paediatric units and includes a yearly subscription for 5 years. HANDi Paediatric has proved to be a profit making innovation (Figure 3: year 1 and 2 finacial statement). Currently 5 acute trusts are using the app and 2 further CCGs have commisioned new versions of the app.
INVOLVEMENT
•Options appraisal was carried out within our own paediatric management and clinical teams – departmental clincal and senior management agreement was obtained
•First version app build was influenced by our patient engagement group and early professional feedback from both primary and secondary care.
•Parent/carer pathways were reviewed by patient engagement members to ensure plain english was used and content was accessible.
•Reskinned versions of the app are reviewed and signed off by commisoners clinical primary and secondary care teams prior to publication.
•Feedback from parents/carers and medical professionals has influenced subsequent improvements to the content and technical interface of the app.
•We have also benefitted from the support and experience of our local academic health service network.
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