Theme 1: Acute paediatrics

Acute illnesses and particularly infections in children are a major driver of consultations in primary care and Emergency Departments. Febrile illness accounts for 20% of all visits to paediatric emergency departments; 30-40% of all NHS Direct calls are for children. There has been a steady rise in unplanned hospital admissions of children (15-22% over the past decade) particularly for short stay unplanned admissions. There is rapid movement away from presentation of acute illness to general practice towards direct contact with emergency services through 111, 999, GP out-of hours services, and direct ED attendance. Unlike traditional general practice, these services tend to escalate rather than absorb the problem, referring perceived risk for assessment or care to the next level up. The consequences for the NHS are failure to meet ED performance targets (e.g. the 4-hour wait) and rapidly rising attendances and admissions. This high volume of care is in contrast to a decreasing incidence of serious infections in children which means clinicians may have little personal experience with early clinical presentations. Unsurprisingly, up to half of children with meningococcal disease are not identified at first contact. Difficulty in recognising serious illness in children both in primary care and in hospital has been identified as one factor contributing to childhood mortality.

This problem will not be solved without strengthening the ambulatory assessment of children with an acute illness. Integrating new IVDs at the point-of-care in the overall assessment in ambulatory settings should result in improved diagnostic precision leading to better referral and treatment decisions. The aim of this theme is to evaluate point-of-care IVD tests in children presenting to various ambulatory acute care settings, including Children’s Decision Units, GP out-of-hours services, and daytime general practice. Evaluations will include accuracy, impact, acceptability, usability and care pathway changes after implementation. The results of these evaluations will then be used to design generic setting-specific evaluation and implementation packages to facilitate the introduction of future point-of-care IVDs in these settings. We work closely with the Oxford AHSN’s Children’s network, a group of 250 professionals who are committed to improving paediatric care across Oxfordshire, Buckinghamshire and Berkshire by speeding up the adoption of innovations and concepts which will add measurable value to children’s healthcare.