The National Children’s Hospital in Tallaght is asking the public to host pancake parties with the aim of raising funds for Ireland’s first Short Stay Observation Unit (SSOU) attached to the hospital.

The unit is due to open in April with capital funding coming from the HSE. But money is needed to equip and develop the unit which will see children being monitored for six hours and, in most cases, being discharged without the distress of admission to a ward. At the moment, there is a 16 per cent admission rate through the emergency department to a ward. When the SSOU opens, the rate is expected to drop to 12 per cent, freeing up much-needed inpatient beds and saving children and their parents unnecessary stress.

The unit will see 7,000-8,000 young patients per year and aims to save more than 6,000 children from being admitted to hospital. Sick children will be cared for in a child-friendly environment.

Dr Turlough Bolger, paediatric consultant in emergency medicine, says the planned SSOU is known as the POD (Paediatric Observation Department).

“It’s part of the new children’s hospital model of care and is kind of a trial run for it when it opens in 2019,” he says. “We’re all going to be learning new skills and developing this type of medicine, which hasn’t been practised here before.

“When you look at children coming into hospital, they tend to be admitted for fairly short periods. The current length of stay in hospital would be less than two days. By putting children into the observation unit, we’ll be reducing admissions on to the ward. We will give children some treatment in the unit and then send them home. It will mean less of the cross-infection that you get on the ward. A lot of paediatric admissions are infectious diseases such as chest infections and gastroenteritis.”

The less time spent in hospital, the better, says Bolger. “Obviously, for the parents, there’ll be less work disruption. Lots of research has shown that parents are really happy with this kind of care. It’s shorter and more focused. There are benefits to the hospital as well, with increased bed capacity for the inpatient beds and for true emergencies.”

Bolger points out that up to now, the Tallaght hospital has “limited space and limited cubicles to assess patients. We want to separate the patients and say that some children have a certain condition that would be [suitable for treatment] in the POD. We can then see the next patient from the waiting room and keep the flow going, resulting in less waiting time.”

Quick diagnosis

Observation medicine involves making a diagnosis and highlighting cases that would be suitable for the SSOU.

“The patient would need a period of observation or a period of intensive treatment. When the patient improves, they can be discharged safely.

“The conditions we’d be looking at would be head injuries, where a child comes in from a rugby match and needs four to six hours of observation. Other conditions would be asthma attacks, for example. Babies who ingest medicines need observation to make sure there are no effects. Children with first seizures, kidney infections or skin infections can either be observed or can be given treatment and observed to see what the response is. A decision can be made after six hours to see whether they can go home.

“We’re hoping there will be very few admitted to the observation unit who will end up staying in hospital. If that were to happen, we’d see it almost as a kind of failure of the system. We’d be confident that more than 90 per cent would end up being discharged.”

When it comes to staff for the unit, Bolger says with reduced admission rates to the ward, “there’ll be some potential for the reallocation of inpatient staff or inhouse staff to work in the unit. I don’t think it will be a problem. Nursing staff and doctors would be very keen to get experience in this kind of care.” Bolger says he has looked at models of SSOU care in the UK including the units at the Salford Royal Hospital in Manchester and at the Alder Hey Hospital in Liverpool.

Success in Mullingar

A paediatric doctor based in the emergency department of the Midlands General Hospital in Mullingar has set up a structure whereby children who don’t need to be admitted to the paediatric ward are brought back for review.

Frances McCartan says the structure, called the paediatric review clinic, hasn’t been formalised but functions well. “Children treated for conditions such as asthma or abdominal pain are brought back within a month to see how they’re getting on. They would have attended the emergency department. We would see if they need more specialist care.”

This system has "made a difference in the number of children being admitted. It has taken the pressure off outpatients and inpatients. About 5,000 children attend the emergency department in Mullingar every year. Since the clinic was set up, we found that from March 2012 to the end of 2013, the figure was down by about 20 per cent. We have presented our experience at a couple of meetings of the Irish Paediatric Association. Our experience shows that people like me can provide a good service that is less stressful for children."

Any funds raised from pancake parties and pancake-flipping competitions in aid of the SSOU can be sent via Freepost to the National Children’s Hospital’s Fundraising Department at Tallaght hospital, Dublin 24. For details, see iti.ms/1zcsbtn