Background and aims Elective medical or specialty admissions often arrive out-of-hours when the admitting team is not available to commence care. Clearly communicating plans for investigation and management to the on-call team can prevent delays to management of these children. This quality improvement project aimed to ensure over 90% of elective medical admissions had a written plan available and treatment started within six hours by September 2017. Methods Standard Quality Improvement methodology was used, including analysis using a driver diagram and PDSA cycles. Data was collected from the charts of electively admitted children every month and recorded whether there was a written management plan, the location of any plan, whether notes were available and clerk in completed and whether planned treatment was started within six hours. The data was analysed using a run chart. Three measurements were obtained between changes to facilitate identification of outliers. Interventions to improve compliance with admission plans included raising awareness through staff training/teaching sessions, providing written guidance to consultants and empowering the bed managers to address the whereabouts of admission plans with the responsible consultants at time of first contact. Results Fewer elective admissions occurred over the winter period than expected as beds were occupied by emergency admissions. A large portion of elective admissions were patients admitted for sleep studies, GI procedures or investigations, metabolic investigations or planned antibiotic courses (Cystic Fibrosis). Of those studied, initially between 20%–60% had both a written plan available and planned treatment started within six hours. Following simple interventions 60%–100% of patients met the standard, however, variability in the data and small numbers mean that work will need to continue to embed these changes so the results are sustained. Conclusions Simple interventions and raising awareness improved adherence to standards for elective medical admissions, however further intervention and support is needed to make this sustainable.
