A first-in-Wales rapid response team is helping to keep vulnerable children out of hospital when they develop potentially serious infections.
Instead the team supports them to be looked after in their own home – and works with families, schools and carers to try and prevent them becoming unwell in the first place.
Launched last year, the Paediatric Respiratory Physiotherapy Rapid Response Outreach Service is available to youngsters aged from two to 18 years with complex medical needs.
It’s not uncommon for children to pick up seasonal viruses and chest infections during the winter months. But those with health conditions and disabilities can be at a higher risk.
Samantha Davies, who manages the paediatric physiotherapy service, said: “Due to protective measures imposed during the pandemic, children and young people were not exposed to the usual childhood viruses.
“This led to a huge surge in respiratory issues following the relaxation of the Covid shielding period.
“Children with complex needs have altered muscle tone that limits their ability to cough effectively and reduces their lung function.
“When they get a chest infection, they end up with a thick mucus called sputum on their chests that they can’t clear by themselves.
“This is where physiotherapists become involved. We use manual techniques such as chest physio and, potentially, suctioning into their lungs to get rid of it.”
The service was introduced to try to manage how the surge in cases of chest infections could potentially impact young people with complex needs, who are at higher risk of contracting them.
Physiotherapists Mari Powell and Briony Guerin make up the team.
“The first element of the service is preventative where we liaise with schools, parents and carers and teach them how to perform prophylactic chest physio,” Mari said.
“It means they can then do it on a daily basis to try and keep their children well.
“The second element is the rapid response where they can call us directly so we can do a telephone triage.
“We can either give advice over the phone or we can go to their house and do a full assessment of the child and carry out chest physio.
“We also get a sputum sample which can be tested in hospital.”
Taking sputum samples at the child’s home means they could receive specific antibiotics targeting the infection rather than general antibiotics.
Samantha said: “Within 48 hours of the sample being taken results are available, allowing Mari and Briony to ring the GP or paediatrician to ask them to prescribe specific antibiotics.
“It also means they could contact the hospital ward in advance to say ‘we’ve tried this but the child is continuing to deteriorate and we feel they need medical care’. Hospital staff would know what had happened up to that point.
“They would also know which IV antibiotics were needed, so as soon as the child arrived on the ward their care would be immediate.
“The result is the young person can go home sooner and Mari and Briony can continue visiting them at home to support their hospital discharge.”
Mari added: “They can go back to school sooner and return to family life sooner.
“A lot of these children and young people have specialist postural equipment at home, so keeping them at home means they can still access that too.”
The service has even introduced treatment normally used for cystic fibrosis patients, who can suffer from a build-up of thick, sticky mucus in the lungs.
The drug, DNase, helps to make the mucus less sticky and easier to get rid of.
Samantha said: “We tried it with our patients as we know they have got similar difficulties.
“We found it makes an immense impact.
“Families say their children are sleeping better, their speech and their interaction at school has improved.”
Team members have celebrated some success of their own after being highly commended in the New Ways of Working category at the recent Advancing Healthcare Awards Wales.
Samantha said: “We were absolutely thrilled to find out we’d been shortlisted as finalists.
“We were quite overwhelmed that the esteemed AHA interview panel found the project as worthy as we think it is.
“We received the highly commended for our category, which is quite rare as they generally only give out awards to the winners. The panel thought our project was so close to winning, they wanted to recognise us too.”
Mari added: “We were extremely pleased to be highly commended because the standard was amazing.
“It was great to get that recognition and raise the profile of our service.
“We have been supported by a great team of paediatricians and paediatric nurses, and the children have benefited from the multi-disciplinary team working to streamline their care.
“We have evidence to show that we have already prevented hospital admissions, improved quality of life for the child or young person and their family and improved the patient experience.
“We hope the service can continue to keep this group of patients well in the community.”
