Standardising the care of babies presenting with Prolonged Jaundice

As a GP trainee, I have been fortunate to see the many facets of the patient journey as they navigate primary, acute and secondary care service. My project was inspired from my time as a Paediatric SHO, where I helped run a prolonged jaundice clinic, but found a lack of standardisation in investigations, dedicated clinic slots, and poor communication with primary care referrers (highlighted to me as a GP SHO), and guidance for juniors. I noticed first-hand the anxiety this caused parents and their families – many of them resulting in unnecessary A&E waits and visits, repeat attendances, and increased parental distress.

I wanted to help standardise this care, better integrate these services and improve the patient experience, and thus reviewed audit data collected from A&E and Paediatrics over a 6 month period. More importantly, PICH taught me not to forget the patient and their families at the heart of the project and thus spent time shadowing families on their “Prolonged Jaundice Clinic Journey” from time of their referral, waiting room and clinic experience, and used emotional mapping to understand user stories.

From this, we have been able to implement a dedicated Prolonged Jaundice clinic morning, consensus for investigations, and an agreed pathway of A&E and community triage. We have also utilised the electronic patient shared record system for clinic proforma summaries to communicate with GPs. Based on parental feedback, we have parental information leaflets from the “Yellow Alert” charity and clinician resources distributed to doctors. We also used these as an educational tool for families at a recent community fair stall for members of the local public. From qualitative feedback, parents and colleagues have responded well to the changes.

My PICH project is still a work in progress and in the midst of our re-audit – with preliminary findings highlighting a further need to engage with our community midwifery and health visiting team, and thus my PICH project is still very much evolving!

Top Tips to Share

Use your opportunity as a PICH participant to attend meetings and find out what is happening in your local area. Following the PICH talk on integrated care by Dr Eugenia Lee,  I was able to attend a Healthy London Partnership Children’s and Young Person GP leadership meeting hearing about innovative integrated care projects and developments. I then attended my local CCG meeting, and finding out about projects co-designed by children and young people in my borough.

If I could do it all again…

Spend time thinking about all the stakeholders in the project – there may be many more than you think! Try see if you can arrange to speak to stakeholders directly, especially if emails are not proving any response.

Have a constant contact in your department to give you ground feedback– helpful for trainees who rotate departments, hence having a PICH champion is very helpful in this respect. There are many children charity organisations that will send you free patient and clinician information packs, and useful when needing resources or patient friendly material.