2. This is the biggest, trainee led, prospective national paediatric audit to date Our hospital is taking part

3. Guidelines
RCOA recommends that hospitals regularly audit their unplanned admissions[1]
Adult unplanned admission rates should be <2% [2,3] & paediatric rates should approximate to this[4]
1. Guidance on the Provision of Anaesthetic Services (GPAS). Royal College of Anaesthetists. 2016
2. Raising the Standard: a compendium of audit recipes. Section 5: Day Surgery Services, Section 9: Paediatrics. Royal College of Anaesthetists. 3rd edition, 2012
3. Paediatric day-case surgery: an audit of unplanned hospital admission Royal Hospital for Sick Children, Glasgow. Blacoe DA, Cunning E, Bell G. Anaesthesia. June (6):
4. Awad IT et al. Unplanned hospital admission in children undergoing day-case surgery. European Journal of Anaesthesiology. May 2004:21(5):

4. The Problem
Rate of unplanned paediatric day case admissions unknown in UK
More information is needed to identify what factors contribute
Eg ASA, pre-assessment, surgical procedure, surgical duration,
We may identify interventions that could reduce unplanned admissions

5. Phase I Retrospective audit (1st Jan 2016 – 31st Dec 2016)
Data from 48 hospitals
This provided an estimate of:
No. of paediatric day case anaesthetics in the UK
No. of admissions
Retrospective phase has been performed (Phase 1)
The aim of this was to gauge the approximate number of day case general anaesthetics performed and the
number of unplanned admissions in the study hospitals over a 12 month period.
A total of 63 hospitals engaged in Phase 1.
48 hospitals were able to provide a full data set. 16 hospitals were unable to access the data from their computer systems. A further 20hospitals have shown interest in engaging with the prospective phase (Phase 2).
Based on the figures collected from Phase 1, the total annual day case procedures for the 48
hospitals contributing data was 101,381cases, with 4515 admissions. We estimate that the monthly caseload
would be approximately 8448, with 376 unplanned admissions for these 48 hospitals. We are aware that there may
be some data inaccuracy owing to the retrospective study design. We aim to increase the size of these figures by running Phase 2 for 6 weeks and to recruit more than 48 hospitals.

6. Phase II Is registering now! We are taking part
Phase II is national and prospective
Data collection 10th October – 21st November 2017

7. Phase II aims
Prospectively identify proportion of unplanned admissions
Across the UK
In specialist & non-specialist centres
Identify common contributing factors involved in unplanned admissions
Generate data for future quality improvement projects

8. Phase II Data Collection
All patients 0-16 listed for a day case GA procedure
Elective or Urgent/Emergency
Includes Endoscopy & Radiology
Unplanned admission is considered as :
ANY paediatric patient, who on arrival to hospital did not have an overnight bed booked who subsequently stays overnight
This will help pick up those cases inappropriately booked or “forgotten” about
No patient identifiable data will be collected.

9. Phase II Data
For each unplanned admission the following data will be collected:
Patient demographics
ASA grade, procedure, specialty, timings
Reason for admission

10. Running Phase II in Your Hospital
Team - Consultant supervisor, PATRN representatves
Register your centre with PATRN
Registration is now open
Registration (intent of participation) deadline 8th September
Register the project with your local audit department now
Data collection 6 weeks 10th October –21st November See ‘Getting Started’ document

11. Running Phase II in Your Hospital
Ethics are not required for this audit project
Patient consent is not required for this audit project
PATRN CANNOT ACCEPT YOUR DATA WITHOUT LOCAL AUDIT APPROVAL
Deadline 6th October 2017 but please return before this so we can get your login to the secure data portal to you. 

12. Data Collection Advertise & promote the study
Work out your hospital logistics and a robust strategy
How will you identify unplanned admissions?
Day ward, bed managers, recovery staff
Please see our data collection guide for suggestions

13. At the end of Data Collection
All data needs to be uploaded by 20th December 2017
Extract total number of planned day case procedures from your theatre IT system (with help!) at the end of the 6 week data collection period
Please remove hospital numbers from your data and make sure you send age, not DOB
Certificates of contribution by Feb 2018 & aim to publish analysis of results Autumn 2018

14. Thanks!

15. Further information: https://twitter. com/patrn_apagbi https://www
References
1. Guidance on the Provision of Anaesthetic Services (GPAS). Royal College of Anaesthetists. 2016
2. Raising the Standard: a compendium of audit recipes. Section 5: Day Surgery Services, Section 9: Paediatrics. Royal College of Anaesthetists. 3rd edition, 2012
3. Paediatric day-case surgery: an audit of unplanned hospital admission Royal Hospital for Sick Children, Glasgow. Blacoe DA, Cunning E, Bell G. Anaesthesia. June (6):
4. Awad IT et al. Unplanned hospital admission in children undergoing day-case surgery. European Journal of Anaesthesiology. May 2004:21(5):