North London Partners in health and care

How group consultations for families whose children have asthma is helping improve outcomes

Ana Marote
Asthma Paediatric Clinical Nurse Specialist, Whittington Health NHS Trust.

I’m Ana and I am one of the Paediatric Asthma Nurses at the Whittington Hospital. We’ve started holding consultations for group of families whose children have asthma to see if this can improve outcomes, read on to find out if it worked.

We are always keen to try new things in order to adapt to our patient population and try to engage our children and parents while also improving the way we work.

Just over a year ago, July 2018, we trialled group consultations for children under 5 with wheeze. We were inspired to do so as there was evidence that group consultations offered improved outcomes for adults with long term health conditions. These are consultations delivered by a clinician in a group setting rather than meeting patients for a one to one appointment. We wanted to see if the same model could be used in paediatrics and have equal, if not better, outcomes.

The group consultations are offered to families of children who recently attended the emergency department for a viral induced wheeze and needed a follow-up appointment in four to six weeks.

Groups of families met with two nurses and an administrator who work with parents to uncover concerns and answer questions, carry out diagnostic checks, carry out 1-to-1 reviews and develop care plans - while the children play happily nearby.

In the beginning it was a hard slog as we had to change everything about the process involved in an outpatient appointment, from the ability to book more than one patient into a time slot to finding an area that could accommodate everyone within a clinical setting. There were times when we thought we would stop and go back to the classic one-to-one clinic appointment but the parents gave such positive feedback that we kept going.
They spelt out the benefits to us: “We are with people who understand the struggle and can relate to us.” When I heard this I realised why it worked.
At times during the consultations, I could take a step back and allow parents to talk each other through the benefits versus side effects of inhaled corticosteroids… A parent’s voice was far stronger than mine in creating a convincing argument!

We evaluated the clinic, 24 families responded and 58% reported that they learnt something new from their peers and 50% felt the review built their confidence to take control of their child’s health condition. … These are encouraging statistics!

There were also benefits to the hospital, it saved hours of nursing time that can now be used for other duties and led to a 31% reduction in missed appointments.

Other benefits include:

• Parents being able to compare symptoms and meet others in the same boat
• Parents benefitted from hearing the answers to questions they had not thought to ask
• Parents felt it was a safe space to share their concerns in a relaxed social environment
• Nurses found it a fun, energising way to practice in a way that supported shared assessment and collaborative working

As we go forward with group consultations, we hope to look at the impact on emergency department attendances and expect that with increased confidence to manage their children’s condition, parents are less likely to attend. We also hope that, as group consultations continue to evolve, we can look at different age groups of patients and look at whether this would work with our teenagers and help prepare them for transition from children’s to adult services.

I think the big thing for families is that group consultations helps them realise that they are not alone. This way of working has shown that if we want to improve outcomes we need to think outside of the box…

I think the ideal would be to have a parent as part of our team, as a facilitator as I do believe that this could have the biggest impact!