SaHF DMBC Volume 1 Edition 1.1.pdf - Shaping a healthier future

Illustrative patient journey in paediatrics – Laura’s asthma attack
Out-of-hours
GP visit
▪ Laura is 6 years old and has asthma. On Sunday, Laura starts
wheezing badly and has some difficulty breathing. She has a
temperature.
▪ Laura‟s mother calls 111. She speaks to a nurse who asks questions
to understand Laura‟s condition, and advises her to go to the Urgent
Care Centre to see a GP.
▪ Within 10 minutes of arriving at the UCC she sees a GP who starts her
treatment immediately. Within an hour Laura has stopped wheezing.
A&E
▪ Within 4 hours her symptoms suddenly deteriorate. Her mother calls
111 again; as her breathing problems are severe now the nurse
advises her parents to take her to the nearest A&E.
▪ On arrival, the triage fast-tracks her to be seen immediately in
paediatric A&E
▪ Treatment is effective and Laura soon gets better. In an hour she is
transferred to the children‟s ward by a paediatric nurse.
Paediatric
ward
▪ During the night, Laura‟s condition worsens and the duty paediatrician
calls the duty consultant on-call for the acute retrieval service for
advice.
▪ Laura gets further treatment but transfer to the specialist unit is
unnecessary. Laura steadily improves, she stays in hospital for the
next 2 days and is treated according to the agreed plan.
▪ Laura‟s parents are offered a bed beside Laura in her room in the
children‟s ward.
Discharge
and follow-up
Selfmanagement
and support
▪ Before discharge, a revised asthma action plan is agreed between
Laura, her parents and the consultant. Inhaler technique and
information of what to do if it Laura becomes breathless again are
taught to both Laura and her parents.
▪ A follow-up appointment is booked at the outpatient clinic, a discharge
letter is written to the GP and the GP receives an update to Laura‟s
patient record about her admission to hospital.
▪ Laura‟s parents are given a phone number to call, if Laura‟s condition
deteriorates again.
▪ In her follow-up appointment with her GP, the GP discusses with
Laura‟s mother how best she and Laura can manage her asthma. She
also has an appointment with the asthma specialist nurse.
SOURCE: RCPCH 2007/2011, DH 2006, RCoA 2005, CSF 2007, NICE 2007, PICS 2001
7a. Clinical vision, standards and service models 140