Patient flow at Bristol Royal Hospital for Children

As part of an ambitious project to help Bristol Royal Hospital for Children (BRHC) cope more effectively with winter pressures, staff developed a wide-ranging ‘flow’ programme to ensure BRHC was as prepared as possible for the extra demand.

Flow – key to the success of every acute hospital – refers to the movement of patients, information and equipment between departments and staff groups, as part of a patient’s care pathway.

One key project in the programme is the paediatric outpatient parenteral antibiotic therapy service (p-opat). This enables children and young people who are medically stable, but require prolonged courses of intravenous antibiotics to be managed at home, rather than in hospital. A community nurse visits the patient daily to administer the antibiotics, and the patient is reviewed at weekly clinics by a consultant. More than 50 patients, many of whom are recovering from illnesses such as infections of the bone, chest, skin, heart, or brain, have benefitted from the project so far.

Jolanta Bernatoniene, paediatric infectious diseases consultant and project lead, said: “It’s far more convenient for families to have their child treated in the comfort of their own home. Parents can go back to work and children can return to school. Having more children receiving their antibiotic treatment at home frees up beds for other patients. We’ve had excellent feedback from families whose child is participating in p-opat.”

P-opat is a pilot project commissioned by Bristol Clinical Commissioning Group (CCG). Funding was used to recruit an inpatient clinical nurse specialist to facilitate the service, along with a community nurse to visit patients at home. The team includes an admin member of staff and a part-time consultant in infectious diseases. Community staff had already been providing antibiotic therapy at home for patients where appropriate. But the extra resources made available through the CCG’s funding meant the work could take place on a much bigger scale.

The early results from p-opat are positive. Since the service began, around 100 bed days per month have been saved, enabling the hospital to admit more children and improve the flow of patients through BRHC.

The next phase of p-opat will see the introduction an innovative intravenous pump system (elastomeric device), for patients who need more than one dose of antibiotics a day. The antibiotics are released gradually over a 24 hour period from the pump into a peripherally inserted central line. Every day, the community nurse will visit to replace the pump and check on the patient.

Caitlin Marnell, general manager for children’s medical specialties, said: “When you add up the total of the various elements of the flow programme, it’s clear it’s been a massive success. We have recruited more nurses, we have better communication and we’ve reduced the length of stay for patients, freeing up more beds. We haven’t solved all our problems. There is still much to do and we plan to continue building on the successes of the programme.”

This case study is just one example of the work going on at University Hospitals Bristol NHS Foundation Trust, to showcase innovations to mark NHS Change Day on 11 March.