Organisation

South Yorkshire and Bassetlaw Integrated Care System (SYB ICS).

What was the problem?

The pandemic saw workforce pressures increase, trusts converting operating theatres into critical care beds, and anaesthetists re-allocated to focus on intubation of critical patients. SYB clinicians recognised this environment may impact negatively on care for children.

What was the solution?

A new integrated care pathway saw children assessed on pickup by the ambulance crew, supported remotely by a clinician at Sheffield Children’s Hospital to help decide where to take them. This ensured children got timely emergency surgery and freed up space in general hospitals for COVID patients and elective care.

All children under 16 needing emergency surgery went to Sheffield Children’s Hospital; those needing time-critical surgery continued to the nearest district general hospital (DGH) emergency department (ED). Any patients walking into their local ED or GP practice were assessed and transferred to Sheffield Children’s Hospital if they needed surgery.

What were the results?

The new pathway has so far helped over 630 patients during the pandemic.

Professor Des Breen, SYB ICS Medical Director, said: “Transferring children who needed emergency surgery to a single site at Sheffield Children’s Hospital allowed children and families to continue to receive high quality and safe emergency care at a time when health services were struggling with demand and within the agreed waiting times.

“We were also able to lower the COVID risk to those children and their families; and at the same time, increase capacity in our local hospitals, enabling them to care for greater numbers of adult COVID patients and higher levels of elective activity.”

What were the learning points?

Partners in the SY ICS which helped design the pathway include the local clinical commissioning group, hospital trusts, general practices and ambulance services.

Professor Breen: “Working together during two waves of the pandemic and having had to stand down the emergency pathway and then stand it back up again has enabled all partners involved to see the speed at which such mutual aid action, ie working together, can really benefit patients.

“The legacy of this joint working approach is that services for children are more unified across South Yorkshire, children should receive the same standard of care, it should be equal, and this new way of working has definitely helped achieve that.”

Next steps and sustainability?

This Children’s Emergency Surgery Pathway can step up and down ensuring children still get surgery even when services are under pressure.