title: Multi-method evaluation of a paediatric ambulatory care unit (PACU): impact on families and staff.
abstract: OBJECTIVE
  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 A&E (PACU: 51%, A&E: 31%; p = 0.03). Further, over three quarters (77%) of PACU parents preferred the new model to traditional A&E services. They reported receiving sufficient information (93%), reduced anxiety (55% anxious before service, 13% anxious after; p<0.001), "quick" waiting times (median: 35 min), 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Imperial College, London and River Island Paediatric and Child Health Academic Centre, Northwick Park Hospital Campus, Harrow, Middlesex, UK. m.blair@imperial.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Blair
authors.forename: J
authors.initials: J
authors.lastname: Gore
authors.forename: F
authors.initials: F
authors.lastname: Isaza
authors.forename: S
authors.initials: S
authors.lastname: Pajak
authors.forename: A
authors.initials: A
authors.lastname: Malhotra
authors.forename: S
authors.initials: S
authors.lastname: Islam
authors.forename: T V
authors.initials: TV
authors.lastname: Vigneswaran
authors.forename: P
authors.initials: P
authors.lastname: Lachman
mesh_terms: D000553:Ambulatory Care / Q000592:standards*; D000554:Ambulatory Care Facilities / Q000592:standards*; D002648:Child; D002662:Child Health Services / Q000592:standards*; D002675:Child, Preschool; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010290:Parents / Q000523:psychology; D017060:Patient Satisfaction; D010817:Physician-Patient Relations / Q000941:ethics; D012017:Referral and Consultation / Q000706:statistics & numerical data