Multi-method evaluation of a paediatric ambulatory care unit (PACU): impact on families and staff

Aim: To assess the impact of a purpose-built, short stay paediatric ambulatory care unit (PACU) on the patient journey and perceptions of parents, staff and referrers. Methods: Multi-method evaluation, including a parent survey (n=104), patient journey mapping (n=10), staff interviews (n=10), a referrer survey (n=16), routine activity analysis, and a comparison with the A&E service (A&E parent survey: n=41). Results: Almost all parents attending PACU (94%) were satisfied with the service and significantly more likely to feel "very" satisfied than parents attending AE AE p=0.03). Further, over three quarters (77%) of PACU parents preferred the new model to traditional AE 13% anxious after, p=0.001), "quick" waiting times (median: 35 minutes), and enhanced confidence (87%) and understanding (89%) in dealing with their ill child. The number of stages in the patient journey was reduced from six ("traditional" A&E pathway) to four (PACU pathway). Staff and referrers reported this was a "superior" model to A&E, but that improvements were required around appropriate referrals and the need for more multi-disciplinary protocols and liaison. Conclusion: Our study suggests that the PACU model is perceived to be an effective alternative to standard A&E services for the assessment and early management of acutely ill children and their families attending a hospital. It is highly valued by users, staff and referrers and enhances the patient journey. Lessons learnt include the need to enhance multi-disciplinary processes and clarify the role of this form of acute care provision in the wider healthcare system.