What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

At our setting, circa 70 newborns attend emergency department (ED) for jaundice assessment and treatment. ED is not an appropriate location for a postnatal mother and her baby. Newborn jaundice assessment, treatment and monitoring is heavily diagnostics dependent and currently this equipment (blood gas analyser with serum bilirubin testing module) is only available in hospital environments. However, this model results in long waits in ED, poor family experience, risk of infection to newborn and potential delays in treatment. There is risk of separation of mother and baby if newborn in admitted to neonatal unit or paediatric ward which adversely impacts on breastfeeding and bonding.
Hospital based care is more expensive and likely to be less cost effective. Long term impact on mother’s mental health as well needs to be considered.

What does your project aim to achieve?

This project seeks to improve family experience, reduce wait times in emergency departments, mitigate the risk of infection, and alleviate pressure on emergency services through the implementation of community-based testing, home phototherapy, supported by virtual consultations and direct assistance from community paediatric nursing teams.

Achieving this will allow development of virtual consultation platforms connecting community clinics with hospital specialists for guidance on complex cases along with enhanced collaboration between hospital and community healthcare providers reducing waste and optimal utilisation of resources.

How will the project be delivered?

This project brings together healthcare professionals working across primary and secondary care and families of newborn infants.

We will establish mobile community clinics/hubs equipped with necessary testing equipment for jaundice assessment. We will provide training and support to community paediatric nursing teams for conducting assessments and administering standard phototherapy.
Virtual consultation platforms connecting community clinics with hospital specialists will be developed for guidance on complex cases.
We will develop a structured operating procedures and protocols to mitigate risk ensuring high risk infants are reviewed immediately in the hospital.

With a large number of stakeholders across a wide geographical area we will appoint a project administrator/consultant to ensure effective operation throughout the project.

We will measure impact by evaluating patient outcomes, family satisfaction, and do a cost effective analysis to assess the effectiveness of the initiative.

How is your project going to share learning?

Learning will be transferable to other clinical pathways in neonatology and paediatrics e.g. prolonged jaundice screens, crying baby clinics.
Spread to other neonatal units within the Local Maternity and Neonatal Systems (LMNS), Neonatal network and nationally to other neonatal units through British Association of Perinatal Medicine (BAPM) and BLISS Charity.
Virtual hospital wards are being incorporated into Trust EPR and this will serve as a transferable template to other units aspiring to innovative integrated care initiatives such as this.