Background In response to the coronavirus pandemic, the paediatric team have needed to make rapid changes to our pathways and ways of working. In this time colleagues have fast tracked the testing of new processes and generated ideas to deliver continuous improvement.

Objectives General objective: To capture the rapid changes made to healthcare practices within the Paediatric department at Musgrove Park Hospital, Taunton in response to the coronavirus pandemic and to share learning across the directorate.

Specific Objectives

• To capture the strategies used to strengthen services and pathways for children, young people and families

• To identify the barriers to better patient care within the paediatric department

• To facilitate shared learning

Methods In June 2020, to capture the rapid changes in response to the coronavirus pandemic, the quality improvement ‘Change Wall’ initiative was used. Core teams and individuals in the paediatric department at Musgrove Park Hospital were asked five questions regarding changes to the department based on plan, do, study, act (PDSA) cycles. Responses were collated and shared via a wall display to disseminate key learning points.

Results We had responses from 13 teams within the paediatric department. Results showed respondents were broadly aiming to address three aspects of care in response to the coronavirus pandemic: ensuring appropriate and timely paediatric support for the acute services; striving to continue to maintain high quality communication with patients and their families; and to alter the physical environment in order to reduce the potential transmission of COVID-19.

Data captured showed multiple initiatives have been introduced. A key development was the introduction of a second paediatric high dependency area. An outpatient department working party was established and the waiting lists for new patients reduced from six months to two weeks. With paediatric oncology patients no longer able to ring the bell to celebrate the end of their treatment, a ‘party in a box’ was introduced.

To be able to provide greater out-of-hours support, the children and young people’s mental health team and diabetes nursing team flexed their patterns of working.

Colleagues in the children’s eating disorder service have changed their working too, which has helped to prevent long inpatient admissions. In one innovative case, they offered nasogastric tube feeding top ups at home, supported by the children’s community nursing team, and prevented a child from being admitted to the most specialist care for four to six months.

Conclusions Overall, many of the changes have been felt to be positive and are being evaluated to continue long term because of the perceived benefit to patient care and the potential to ease winter pressures. We plan to continue to use the change wall to capture changes made within paediatrics beyond coronavirus. This will allow us to continue to disseminate knowledge of changes happening and inspire further change. We plan to re-visit each team in the next six months to explore which improvements have been sustained or adapted. Moving forward we also aim to capture the view of the patient and parent/carer with regards to their perceptions of changes made.