Identifying and prioritising future interventions with stakeholders to improve paediatric urgent care pathways in Scotland, UK: a mixed-methods study

Emma King (Lead / Corresponding author), Emma France, Cari Malcolm, Simita Kumar, Smita Dick, Richard G. Kyle, Philip Wilson, Lorna Aucott, Stephen Turner, Pat Hoddinott

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
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Objectives: To identify and prioritise interventions, from the perspectives of parents and health professionals, which may be alternatives to current unscheduled paediatric urgent care pathways.

Design: FLAMINGO (FLow of AdMissions in chIldren and youNG peOple) is a sequential mixed-methods study, with public and patient involvement (PPI) throughout. Data linkage for urgent admissions and three referral sources: emergency department, out of hours service and general practice, was followed by qualitative interviews with parents and professionals. Findings were presented and discussed at a stakeholder intervention prioritisation event.

Setting: National Health Service in Scotland, UK.

Participants: Quantitative data: children with urgent medical admission to hospital from 2015 to 2017. Qualitative interviews: parents and health professionals with experiences of urgent short stay hospital admissions of children. PPI engagement was conducted with nine parent-toddler groups and a university-based PPI advisory group. Stakeholder event: parents, health professionals and representatives from Scottish Government, academia, charities and PPI attended.

Results: Data for 171 039 admissions which included 92 229 short stay admissions were analysed and 48 health professionals and 21 parents were interviewed. The stakeholder event included 7 parents, 12 health professionals and 28 other stakeholders. Analysis and synthesis of all data identified seven interventions which were prioritised at the stakeholder event: (1) addressing gaps in acute paediatric skills of health professionals working in community settings; (2) assessment and observation of acutely unwell children in community settings; (3) creation of holistic children's 'hubs'; (4) adoption of 'hospital at home' models; and three specialised care pathways for subgroups of children; (5) convulsions; (6) being aged <2 years old; and (7) wheeze/bronchiolitis. Stakeholders prioritised interventions 1, 2 and 3; these could be combined into a whole population intervention. Barriers to progressing these include resources, staffing and rurality.

Conclusions: Health professionals and families want future interventions that are patient-centred, community-based and aligned to outcomes that matter to them.

Original languageEnglish
Article numbere074141
Number of pages12
JournalBMJ Open
Issue number10
Early online date12 Oct 2023
Publication statusPublished - 12 Oct 2023


  • accident and emergency
  • Paediatric A&E and ambulatory care
  • Patient Participation
  • Qualitative research

ASJC Scopus subject areas

  • General Medicine


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