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Theme 2: Evaluation of paediatric outreach services


To evaluate the need for and impact of paediatric services led by Birmingham Children’s Hospital NHS Foundation Trust, with the objective of improving care and patient outcomes.

Our approach

We explored parent, child and staff perspectives of access, attendance and health spaces using qualitative and quantitative methods. Service outcomes, demand, capacity and attendance were investigated through statistical analyses of routinely collected health service data and newly collected data. We also worked on other research projections to help fulfill the Trust's strategic aims i.e. asthma care, electronic advice and guidance service, emergency care pathway redesign, handover at night and health promotion. Research findings were fed back to NHS stakeholders in order to contribute to future service development and improvement.

Our projects

Staff, Parent and Patient Experience of General Paediatric Outpatient Clinics in Hospital and Community Settings

The aim of this project was to explore staff, parent and patient views and experiences of delivering and receiving general paediatric outpatient care in hospital and community settings. Individual interviews were used to collect qualitative data from staff, parents and young people which was analysed using thematic framework and descriptive phenomenological approaches. A meta-synthesis of qualitative literature on families’ experiences of receiving specialist paediatric care outside of a hospital setting was also conducted. Findings hold implications for paediatric outpatient service design and implementation of Care Closer to Home Policies. Findings from the staff study of this project can be accessed at

Access and Attendance at General Paediatric Outpatient Clinics in Hospital and Community settings

The aim of this project was to understand non-attendance at general paediatric outpatient clinics in hospital and community settings. This project encompassed interviews with parents and staff (analysed using qualitative framework analysis), statistical analyses of hospital data, questionnaire study exploring the aim as well as a systematic literature review. Implications of this work included studying the factors involved in family non-attendance and feedback on whether satellite clinics can improve access and reduce missed appointments.

PORTAL (Paediatric Outpatient Referral Triage And Liaison Service) Evaluation

The aim of this project was to evaluate how effective the PORTAL triage service was during its pilot. The study gained feedback from GPs, consultants and other people involved in using PORTAL, and discovered how PORTAL was used during the pilot. The initial evaluation of PORTAL was successful and showed that both GPs and consultants were generally happy with the service, apart from a few teething problems.

Hospital at Night Handover

Hospital at Night (H@N) project is the implementation of an intervention to improve H@N handover policy and procedures, and evaluate it. This project was funded by the Health Foundation, and Theme 2 evaluated specific components: culture, conduct and communication in handover meetings, which were not be covered by the Health Foundation evaluation. Eighteen meeting observations were done prior to the intervention starting to provide a baseline. A summary of issues observed has been provided to the Trust to feed into improvement work. A repeat the observations took place after each of the three intervention stages and a final analysis compared culture, conduct and communication after each intervention stage. Data from the electronic system used by staff to communicate was also be explored, to provide both qualitative and quantitative data on how the system was used.

Emergency Care Pathway Redesign Evaluation

The aim of this project was to follow the redesign of the emergency care pathway (ECP) from inception to completion, evaluating the impact of the redesign within the first year of implementation, and providing the redesign team with intelligence throughout the project to aid decision making. This was achieved by measuring the success of the ECP redesign in improving performance on various quality indicators and A&E standards, measuring patient, parent and staff satisfaction. A discharge review census was completed to cover 170 of the beds in the hospital and an experience-based design methodology was used to understand the experiences of staff, patients and parents.

Health Promotion and Brief Opportunistic Advice Evaluation

The aim of this project was to explore Birmingham Children's Hospital’s clinical staff perspectives in relation to providing healthy lifestyle brief opportunistic advice (BOA) to children, young people and their families within the hospital setting. Clinical staff participated in short semi-structured one-to-one interviews. A thematic analysis and framework analysis were conducted. The results have been used to help stakeholders understand barriers to integrating BOA into routine practice and identify what support is required.

Asthma Emergency Department Admission Evaluation and Intervention Design

The aim of this project was to develop a behaviour change intervention to reduce paediatric asthma admissions tailored to the needs of the local Birmingham population. This was done by exploring quantitative data on asthma paediatric emergency department admissions, exploring asthma illness perceptions and experiences in a qualitative project (via children focus groups and parental interviews), and by developing and piloting an evidence-based behavioural-education intervention informed by the preliminary research and intervention mapping. The intervention was implemented and reviewed at the end of six months to evaluate if it had been effective in reducing ED asthma admission rates. This project was in collaboration with Heart of Birmingham PCT who funding the project; the Birmingham Children's Hospital respiratory department and the George Coller Specialist Asthma Nurse were also involved.

Author(s) Title Journal Publication date
Cameron, E; Heath, G; Redwood, S; Greenfield, S; Cummins, C; Kelly, D; Pattison, H Healthcare professionals’ views of paediatric outpatient non-attendance: implications for general practice Family Practice
doi: 10.1093/fampra/cmt063
15 November 2013
Heath G, Redwood S Paediatric ‘Care Closer to Home’: stake-holder views and barriers to implementation Health & Place
25 May 2012

Theme lead

Dr Vinod Diwakar, Chief Medical Officer, Birmingham Children’s Hospital NHS Trust

Dr Carole Cummins, Senior Lecturer, University of Birmingham

  • Aston University
  • Former Heart of Birmingham teaching Primary Care Trust
  • University of Birmingham