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Meet the team: #takesavillageQI

Also:

  • Dr Elizabeth Wortley, ST6 Paediatrics, The River Island Academic Centre, Northwick Park Hospital
  • Prof Mitchel Blair, Professor of Paediatrics and Child Public Health, The River Island Academic Centre, Northwick Park Hospital

The Challenge

2895 under 1year olds attended our Paediatric Emergency Department in 2017.  Of these, 1060 (36%) were under 28 days old and over 600 (60%) had a diagnosis of problems related to feeding or “well baby”.

Our hospital is mentioned in the UNICEF report on improving uptake of breastfeeding4, and yet we still see a number of babies coming to the Emergency Department (ED) with problems relating to this.  Over the years a number of attempts have been made to address this issue, with limited impact on the number of attendances.  What’s going on?  Where are these families falling through the net?

By the time families are in the ED and struggling, much has happened to undermine the mother’s confidence in breastfeeding and in some respects this represents a late presentation of the problem.  Ensuring she can build confidence back up again, and successfully continue to breastfeed is vital.  We know that positive attitudes and interaction with healthcare staff are vitally important to ensure mothers continue to breastfeed and feel supported2.  Unfortunately, the ED is unlikely to be the appropriate place for this time-intensive, exploratory and supportive work to take place.  

Our Proposal

Current AIM: to reduce the number of <28 day olds coming to our Emergency Department with a feeding problem or “well baby” diagnosis by 10% over 6 months

Using established QI methods, we are still in the “discovery phase” of this project and developing our logic models, which we will upload here as the project progresses.   Areas we know from our initial data require attention are:

Process mapping:  Parental experiences – interviews (personnel time in community and creche facilities) why do some choose the ED; and why do others not

Staff influence and insight: Staff experiences and peer-to-peer attitudes and knowledge (surveying staff and statistical support)

Co-production of interventions with staff and families (creche facilities and facilitators time)

There is a growing and well-established body of evidence about the benefits of breastfeeding to mother, child and family.  These span from health, intelligence, bonding, economic and environmental benefits which are now considered indisputable1.  Economically it is thought that improving breastfeeding rates is one of the most effective public health measures that can be taken4.

For those parents who do manage to access timely support, there is a high degree of satisfaction so why are others ending up in the ED?  Using an exploratory and co-production method we are interested to understand at an individual level why parents are coming in via the emergency route, and why others are not.

We’re also interested in staff experiences, confidence and knowledge in managing these babies.  What impact is their own story having on the outcomes for our patients?2

Once we have a greater understanding of the scale of the problem locally, we would like to adapt and co-produce a suitable intervention to help these families before they get to the Emergency Department.   

 

The benefit to Mothers, babies, families and staff

Benefits to mothers and babies would be by improving breastfeeding outcomes.

We know that ongoing, multi-professional and community peer-to-peer education and support of families is key to breast-feeding success3.  We aim to improve our family’s early days by enabling them to feel supported, empowered and confident in their abilities to understand and feed their baby.

Benefits to staff include improved job satisfaction by greater empathy, knowledge and abilities to manage these babies more confidently in the future.

Benefits to the wider community by improved healthcare spending would be ongoing.  By seeing less babies in the ED before 28 days old we would save money, as well as improving health down the line for both mother and child (maternal cancer rates, admissions for infections), saving future costs.   The full financial gains from such multiple & multi-faceted benefits can never fully be captured as the positives are far-reaching in terms of savings to the environment, improved mental health and intelligence (earning potential) of future generations4.  The social and ethical reasons to support such work are rarely disputed. 

We would measure these changes by:

          Improved attitudes and knowledge of staff by pre- and post-intervention surveys

          Improved signposting to parents after birth measured by parental perception

          Improved confidence of parents in feeding methods

          Reduced attendances to the ED with feeding problems

The benefit to the Q community

We plan to disseminate our findings and develop an education package for our staff that we would share with the Q Community.

We are currently in contact with other trusts to see if they have comparable data, though we know from discussions that this is something other Emergency Departments are also seeing on a regular basis.  We hope therefore that our findings and interventions are applicable to other hospitals and teams across the country.

References:

1.  Victoria. C, Bahl. R, et al. Breastfeeding 1: Breastfeeding in the 21st century: epidemiology, mechanism and lifelong effect.  2016 Lancet 387:475-490

2. Clemison J, Oddie S, Renfrew MJ et al.  Review: Being Baby Friendly: evidence-based breastfeeding support.  Arch Dis Child Fetal Neonatal Ed 2015; 100:F173-F178

3. Rollins N, Bhandari N et al.  Breastfeeding 2: Why invest, and what will it take to improve breastfeeding practices.  Lancet 2016

4. Renfrew MJ, Pokhrel et al.  Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK.  UNICEF UK. Oct 2012

How you can contribute

  • Have you tried something similar locally, providing peer to peer support for new parents? We would be grateful for support and help with regard to any aspect of our project and look forward to collaborating with similar teams.
  • Do you have behavioural insights expertise? We are particularly interested in this aspect of our work and our upcoming interviews with patients and staffs about their decision making.
  • Do you have data regarding the number of under 28 day olds presenting to your local ED? Awareness of the families currently slipping through the net in this regard will allow us to shape an intervention with maximal impact.

Further information

Project Plan – #takesavillageQI FINAL webpage (PDF, 154KB)

Comments

  1. Guest

    Lucy Shapcott 2 years, 10 months ago

    Have been directed to this page by Dr Santhanam (GPIFN).

    Firstly, I am a Nurse Practitioner working in an Urgent Care Centre and am just about to start an audit collecting paediatric ED referral information, if you are also interested in Urgent Care data I could combine this with my audit and collate information regarding presentations and infant. I also undertook most of my SCPHN HV training (as well as peer support training), so tend to deal with a lot of our infant feeding presentations.

    Secondly, as part of the GP Infant Feeding Network, a small group of us (all medics, apart from me) have just started a steering group for a sister group - Hospital Infant Feeding Network - not sure if this would also be of interest to you.

    Regards,

    Lucy

    1. Guest

      Lizzie wortley 2 years, 10 months ago

      hi icy,

      Thank you so much for your comment.  We feel that this is unlikely to just be a problem locally for us, and so we’re interested to see how it compares to other areas/trusts and determine how other teams might deal with it.

      Both my infant feeding colleagues (I’m a Paeds reg) and a team at the Royal college of paediatric and child health (RCPCH) conference this year pointed me in the direction of GPIFN. What a wonderful idea and collaboration! therefore with regards to the hospital infant feeding network I myself am interested and I imagine the owner team would be too.

      Please feel free to contact me at the above email address to collaborate further.

       

      good luck with your work and thanks again for your comment

      lizzie

       

  2. Guest

    Prof. Richard Manning 2 years, 10 months ago

    Comment posted in earlier email

    1. Guest

      Lizzie wortley 2 years, 10 months ago

      Thanks for your comment.  We have tried to contact you as no email has been found by any of us.  We look forward to any further comments you may have to help develop our idea and project further,

      Many thanks,

      Lizzie

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