Project Summary

The Paediatric Observation Priority Score (POPS) is popular, easy to use, and discriminates between children of low and high illness severity. POPS is a checklist; enabling staff of any level of experience to risk assess and prioritise children at the point of entry using routinely collected data.

Please watch this short video to learn more: https://www.youtube.com/watch?v=YwxQrLlAj5M

Proposed education intervention

• Learning resources: a manual including self-testing, supported learning and assessments was created for each site from a common template
• A selection of video clips demonstrating the theory behind POPS, showing POPS in practice, and some examples of key clinical signs in children was made available to all sites
• At each site the educational lead provided one-to-one teaching where possible with staff in their department

Benefits to patients and service

Nurses with a specific remit to deliver education and implementation of the POPS systems were utilised at three Emergency Departments (Leicester, Derby and Mansfield). They delivered patient side teaching to staff members and designed bespoke POPS training packages at each hospital. Regular meetings between the educators allowed the sharing of good practice and development of implementation and research skills.

The Paediatric Observation Priority Score (POPS) fulfils many aspects of QIPP and local CQUINN acute indicators. Low scoring children can be more confidently deflected or discharged without hospital admission. Parents are inconvenienced and may have financial and employment difficulties if their child is unnecessarily hospitalised. Appropriate hospital admission avoidance will reduce associated inpatient costs and release time to care for the sicker children.

Video Presentation

Visit the HIEC archive to read more about the POPS project.

Productivity and impact

The implementation of POPS project at the Leicester Royal Infirmary has seen many positive results.
• Behaviour – A sustained increase in the documentation of a complete set of observations on children presenting with illness was seen from 30-40% (2010) up to 80-90% (2011)

• Function – In a review of 942 cases prioritisation and admission rates increased with increasing POPS. No child with a POPS of 0 was found to have a serious bacterial illness.

• Outcomes – Despite an increase in overall presentations to the Leicester Emergency department (3.7%) since the introduction of POPS there has been overall reduction in the number of admissions (-11.2%) in the most high risk age group (0-1). Initial analysis just for febrile children indicates a potential saving of £66420.

A secondary review has revealed the safety profile of POPS remains very good. In a review of over 21000 presentations only 381 patients returned within a week of their first POPS assessment and only 52 cases had a 1st POPS 0 assessment and then returned with a higher 2nd scores. Of these 41 out of 52 returns were assessed with low POPS scores 1 or 2. Examination of other data is ongoing.

The initial results have prompted a number of centres to become interested in POPS and currently Northampton and Kettering are going to receive HIEC assistance to implement systems in their departments. The complexity of collecting data and a desire to aid introduction and implementation in new environments prompted the creation of ePOPS.

This is a web-based data collection portal, whereby observations which are at extremes are highlighted, and the total POPS calculated. A form with the key information, bespoke to local needs, can then be printed off and the data recorded on an ethics approved server. This system has created significant interest and Bath, Gloucester, Berkshire, Merthyr Tydfil and Poole are also considering or implementing POPS in their Emergency Departments. POPS has also been presented at the 2013 International Forum on Quality and Safety in Health Care. An external validation has also occurred at the North Manchester Acute Hospitals Trust demonstrating POPS is 85% effective at predicting admission.

Project Leads

Dr. Damian Roland, NIHR Doctoral Research Fellow in Paediatric Emergency Medicine

Email: dr98@le.ac.uk

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