Summary

A pilot project implementing pre-existing, free, health and well-being educational digital resources into the paediatric emergency department (PED) to promote healthy behaviours and reduce preventable injuries and illnesses in our local community.

The problem (opportunity)

The Royal Manchester Children’s Hospital sees over 50 000 children annually in the PED, alongside at least 50 000 associated carers. This number is increasing annually, as is the case nationally.1

Our primary role is to treat children with injuries or illnesses, and, if discharging home, to provide relevant health advice. The average cost of a PED attendance is £254.2 In line with the Royal College of Paediatrics and Child Health (RCPCH) blueprint,3 we identified an opportunity to take a more proactive role in health education for our local population to improve family confidence in health and well-being and potentially reduce unnecessary hospital attendances.

Between April 2023 and May 2024, the mean waiting time from triage to clinician was 72 min (range 30–121 min) where wait was ordinarily in the waiting room; the mean wait from arrival to discharge was 211 min (range 156–259 min). This time offered a captive audience and ideal opportunity for both parent and patient education.4

The provision of patient advice using multimedia formats has been shown to be superior to written advice,5 therefore using educational videos in the waiting area would be an ideal format for patients and their families.

Aims

The project aims were to identify the health advice that families and children wanted access to, to display relevant digital resources from recognised sources on pre-existing wall mounted screens in the waiting room, and to measure impact on carer and patient confidence.

Making a case for change

We ran a pre-pilot questionnaire for families attending the PED. We had a 100% positive response to displaying educational videos with high interest in topics including dental hygiene (100%), vaccine advice (100%) and burn management (94.4%).

We identified key areas of preventable PED attendances including road safety, poisoning, safe sleeping for infants, choking, burns and scalds, strangulation, water safety and button battery safety. We then contacted recognised and trusted organisations and gained consent to display their resources in our waiting room (figure 1).

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Figure 1

PED-TV in our waiting room.

The resources were assessed for suitability by members of the PED senior leadership team and, in collaboration with the trust media and communications team, created a 45 min pilot playlist (table 1), PED-TV, which streamed on loop in the PED waiting area 24 hours a day.

Due to the noisy nature of the waiting area, we opted to show muted videos with English subtitles. Where possible, we chose videos that could be followed even without the need for English language knowledge as a large minority of our patients have non-English primary language.

Your improvements

We launched this project during Child Safety Week 2024. In the first 4 months since its launch, 15 152 patients alongside at least as many carers and family members, passed through our waiting area, showing the potential reach of the project for our community.

To measure impact, we undertook a post-pilot survey for children over 8 years old and families. Initial post-pilot survey results indicated high satisfaction with the project and an immediate impact on patient and carer confidence (figure 2).

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Figure 2

Mean change in subject matter confidence from 36 respondents.

Post-pilot feedback showed a 94% positive response to screening the videos in the waiting area, and that subjective confidence in topics shown on the screen significantly increased.

The longer-term aim is for this education to facilitate safe parental management of common conditions and risk reduction at home, which may lead to reducing preventable PED attendances and hospital admissions in the future. While this is not measurable in the short term, audits of number of attendances and reattendances are an ongoing feature of monitoring in the PED and is something we will keep under review as the project becomes more embedded.

Learning and next steps

We serve a very diverse population with a high incidence of childhood poverty and health inequality.6 We initially considered including multiple languages in the playlist, but found this approach to be somewhat unfeasible with the number of languages required. Instead, we are creating a bank of these resources for our PED website, accessed via QR codes embedded in the playlist, enabling children and families to access resources from home. This will include providing these resources in different languages or subtitles to improve access to all members of our community, especially those who speak limited English. We also hope to work with volunteers to create British Sign Language translations of our resources.

Content and feedback will be reviewed and updated biannually by PED senior leadership and monitoring visits to the website may act as a proxy for the level of engagement that the playlist has for families and carers alongside formal feedback.

We plan to roll the project out across the entire hospital trust to standardise carer and patient education across Greater Manchester’s Paediatric waiting areas, making every contact count.

There is a wealth of existing high-quality online resource available to parents and patients, many with RCPCH or National Health Service endorsement, and an enthusiasm from these organisations to share their content for display in hospital free of charge. In our pilot project, we have evidenced that using these resources increases subject confidence within the families attending our PED. The relatively low financial outlay for this project not only empowers families with health education but also has immense potential for financial savings. If avoidable attendances to our department reduced by 1%, this would save the trust almost £125 000 annually.

Given the overwhelmingly positive response received from children, families and the content creators, we are confident that this could be expanded to other hospital waiting rooms across the country. We are happy to be contacted to support other colleagues who are keen to implement similar projects in their emergency departments and can provide contact details for the organisations that we have collaborated with.