PATCH: Foundation doctors meet a new paediatric outreach team

What is PATCH?

Providing assessment and treatment for children at home (PATCH) is a new service based at the emergency department at St Mary’s Hospital, funded by Imperial Health Charity. The team is made up of experienced paediatric nurses and aims to reduce short stay admissions and re-attendance at the hospital for moderately unwell children by using phone call reviews and home visits. It also promotes education and confidence in parents to manage common childhood illnesses at home when safe to do so.

PATCH was conceived in September 2016 by Fran Cleugh, consultant in paediatric emergency medicine, who created the puppet theatre Fix Freddie, and works with Caroline Ward, an experienced paediatric nurse. PATCH currently runs through daytime hours during the week only, though there are plans to expand this in the future.

The team wanted to find out more about their patients’ experiences, as previous feedback by text message and online surveys had not had very high response rates. This is where the two of us, both foundation doctors, got involved.

The questions

First we needed to see for ourselves what PATCH is all about. We shadowed one of the PATCH team in action on a couple of home visits to see a mother with her baby who had bronchiolitis, and a young girl who needed intravenous antibiotics. Perhaps unsurprisingly, the families seemed more relaxed in their own environment compared to what we are used to in hospital. It was an absolute privilege to be welcomed into their homes.

We then researched how to make a good questionnaire, and went through several rounds of feedback from PATCH and the Connecting Care for Children team. Eventually we settled on 12 fairly broad questions, and got started!

The phone calls

Speaking to the parents on the phone felt a bit strange at first. We had been mentally preparing ourselves to follow our questionnaire, even practising it, but actually found it to be a bit restrictive and less useful (or enjoyable!) than having a normal conversation. However, we did use the questions sometimes, for example if parents needed some prompting to remember what happened.

We attempted to call all patients who had had contact with PATCH from October to December, and managed to speak to about a third. Having so many calls go to voicemail was a little disheartening, but our disappointment was completely outweighed by those that did pick up. The vast majority of these sang the praises of PATCH. It was incredibly refreshing to hear such positive experiences, but we did feel slightly guilty as all the compliments were certainly not for us to accept!

So what did we find out?

Although we didn’t manage to speak to everyone seen by PATCH, those from whom we did get feedback were mostly pleased and often quite surprised that the service existed! Many parents found having support from PATCH reassuring, for example knowing “that there would be someone to talk to after going home.” Being able to ask questions in their own environment and learn about their child’s illness was also highly valued, with one parent saying they “definitely feel more confident and in control”, and another that they were “more able to deal with everything going on”. There was also much praise for the “fantastic” nurses, who “went above and beyond”.

By actually speaking to the parents we found out what they really had to say and what was important to them. Compared to feedback by text message and online surveys, this was absolutely invaluable — not just as data for PATCH, but also for us to hear as healthcare professionals. Of course, we had the (quite rare) luxury of time, but the benefit of this to both us and families was most definitely worth it. Our findings are being used to support a case for more funding for PATCH, so it can continue and hopefully more patients can benefit!