My First Family Outing When Newborns come to

“My First Family Outing” When Newborns come to the ED Lizzie Wortley PICH 3. 4. 19

FINDING OUT WHAT’S HAPPENING § Getting hold of data – how why when where § Analysing data – making it meaningful OUTLINE DOING SOMETHING ABOUT IT § Who do I tell & how do I keep them interested? § What about the patients? § What can we do? Is it my job to do it? § What I’ve learned along the way § Where next?

MY MEDICAL LIFE § ST 6 § London paeds trainee § Experience of what a paediatrician can do Background WHAT MATTERS TO ME § My family § Having a purpose

The baby is fine, so should only take 10 minutes Vs The family are struggling, and need to be heard and supported

How could I answer that question?

HRA decision tool

What do I actually need to know? 16 MB Download

What does the data show? Born in hospital 2017 5070 Attend ED 2017 1085 21% 705 14% Hospital birth records & attend ED

My ”Journey”

The hunch is correct – who needs to know?

Stakeholder meeting

§ Don’t let your passion kill other people’s interest

§ “We know” § “Nothing works” What did other people say? § “It was really good once, but they cut funding” § ”you’re putting pressure on new mums” § “it’s …. Ethnic group” § “it’s lack of family support” § “parents expectations are too high” § Cathartic outpourings

What engages people?

How do you make sure you hear the voice of the patient

Cautions?

Patient map Pre-pregnancy Pregnancy • mother fomrula • MW antenatal fed M, BF younger sibling • no 'real' BF experience • Had seen BF in public - just a head againast a chest, "but you don't look" • close friends had kids in USA whilst M living here (tell you things, but not seeing them) care • due to complications of pregnancy so busy talking about current symptoms, m not much talk about after birth • NCT group • one eve class with NCT on BF • takeaway from class was LATCH Labour • 48 hours • friday night to sunday eve • epidural and iv fluids Postnatal HOSPITAL • couple of feeds possibly seen by MW • So busy, know they don't have the time • no BF support worker etc Home (monday) • Think all going ok Home (tuesday) • Breast start to get sore. • Mother comes from USA - says it hurts, so continues as is "toe curling and you just have to get through it" • MW visits - bu more concerned about other effects of delivery than feeding and so not much discussed Home wendesday • feeding now really painful • overnight in tears • calls helpline advised to go to local BF group next day BF group thursday • baby weighed - 12. 9% wt loss • advised A&E • advised dad to buy formula milk A&E (thursday) • Admitted • iv cannula and bloods • iv abx • 3 day admission • EBm and fomrula fed

Methods

Pateints need to drive the change!

§ “I’m sorry I wasn't engaged more at the beginning, what can I do now to help? ” What did stakeholders say later? § “Can I invite someone else along? ” § “WE” § “Let’s do…” § “Can we…”

§ Evidence base § A&E deep dive info § Comparisons with baseline data § Doctor survey Where next? § Stakeholder mapping § The ideas

§ Literature reviews § Why do people come to A&E? Evidence base § Why bring your neonate to A&E? § Do other places have this problem § What is supportive newborn care? § What influences breast feeding success (in itself and as proxy for parenting support? )

Comparisons to baseline data What’s already known?

Does this add up with what’s already known?

Doctors survey

Stakeholder mapping

§ Day 3 visit § Telephone support for one week – proactive § Antenatal match ups with breast feeding groups § Peer support workers on PNW § Best beginnings baby buddy app The ideas § Increase staff training § Antenata classes more parenting classes § Post natal classes

What’s been tried before

Difficulties along the way § Both ‘owning the project’ & being junior – knife edge balancing act § Engagement of management § Co-ordnination of so many teams § Maintaining interest § Infant feeding co-ordinator other interests § Job span

Where next? Harrow Public Health are determined to continue with this work - hospital link Had meeting with CCG head of children’s and presented data – shocked and want to do something Managed to go to a Maternity Voices Partnership meeting – will happily survey on facebook (still need to get confirmation that’s ok) Sustainability – who can continue at hospital site

Contacts and references § @lizziewortley § Elizabeth. Wortley@nhs. net