Evidence into practice
Implementing a unique care bundle for premature babies
Since April 2020 we have worked in partnership with the South West AHSN and South West Neonatal Operational Delivery Network on the rollout of our award-winning PERIPrem care bundle, co-designed with parents and clinicians, to improve the outcomes for premature babies. It is now in use in all 12 maternity trusts across the South West region.
The bundle consists of 11 perinatal interventions, including delayed cord clamping, early breast milk and administration of magnesium sulphate. These have been shown to have a positive impact on brain
injury and mortality rates amongst babies born prematurely.
Quality improvement (QI) methodology was at the heart of implementation, alongside coaching and forging new ways of working. Clinicians from obstetrics, midwifery, and neonatal care joined together as a perinatal community to drive forward and revolutionise care for preterm babies.
To date at least 1,989 babies in the South West have been cared for using the PERIPrem bundle. Modelling indicates that if PERIPrem were adopted nationally, the lifetime health and social care costs avoided by the NHS resulting from severe brain injury for very preterm babies would be in the region of £290 to £370 million per year.
The National Neonatal Audit Programme’s latest report showed units across the South West achieved on average the highest rate of delayed cord clamping at 68.1% (against a national average of 43%). Evidence shows that delayed cord clamping reduces death in preterm babies by nearly a third.
On average, South West units also achieved the second highest rates of maternal early breast milk, the second lowest rates of necrotising enterocolitis (NEC) and the third lowest rates of mortality to discharge for babies born at less than 28 weeks across England.
PERIPrem Cymru launched in Wales early in 2023, and we have supported its adoption and spread through sharing and adapting materials developed during the initial project. NHS Wales Executive have commissioned us to provide programme management and clinical leadership support during the initial set-up phases of PERIPrem Cymru.
Find out more about PERIPrem.
Supporting diagnosis of ADHD
Along with AHSNs across the country, we have continued to implement objective testing using the
QbTest tool to support diagnosis of attention deficit hyperactivity disorder (ADHD) and reduce waiting
times through our Focus ADHD programme. Diagnosis of ADHD can take significant time and resources, with an average 18-month wait for accurate diagnosis.
We have supported six children and adolescent mental health services (CAMHS) or community paediatric services in the West to implement QbTest. In our region, 428 patients were assessed in 2022/23 using the QbTest, and a total of 715 patients since the start of the programme.
Together with the South West AHSN we host a community of practice, exploring innovation needs on the children and young people’s neurodiversity pathway. The online community is open to commissioners and service leads in children and young people’s mental health, as well as those working in community paediatric services, supporting ADHD assessment.
Read more about Focus ADHD
Improving the management of high impact users in emergency departments
An NIHR ARC West evaluation of our programme to improve how ‘high impact users’ of emergency departments (ED) are managed, has shown it to be successful in reducing ED attendance and hospital
admissions among these patients.
In England, patients who attend EDs five or more times a year represent 2% of attendees but account for 11% of attendances. These patients, known as high impact users, have often experienced extremely challenging situations in their lives. This can include experiences of violence, exploitation, alcohol and drug abuse, homelessness, chaotic life conditions, chronic pain, complex medical conditions, and mental health conditions.
Our ‘Supporting high impact users in emergency departments’ (SHarED) programme supported all six EDs in the West of England to introduce personalised care plans for high impact users.
Across the 148 high impact users enrolled during the six months before and after the programme, SHarED led to a 33% reduction in ED attendance and a 67% reduction in hospital admissions.
Read more about SHarED here.