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Objective To inform interventions focused on safely reducing urgent paediatric short stay admissions (SSAs) for convulsions. Methods Routinely acquired administrative data from hospital admissions in Scotland between 2015–2017 investigated characteristics of unscheduled SSAs (an urgent admission where admission and discharge occur on the same day) for a diagnosis of febrile and/or afebrile convulsions. Semi-structured interviews to explore perspectives of health professionals (n = 19) making referral or admission decisions about convulsions were undertaken. Interpretation of mixed methods findings was complemented by interviews with four parents with experience of unscheduled SSAs of children with convulsion. Results Most SSAs for convulsions present initially at hospital emergency departments (ED). In a subset of 10,588 (11%) of all cause SSAs with linked general practice data available, 72 (37%) children with a convulsion contacted both the GP and ED pre-admission. Within 30 days of discharge, 10% (n = 141) of children admitted with afebrile convulsions had been readmitted to hospital with a further convulsion. Interview data suggest that panic and anxiety, through fear that the situation is life threatening, was a primary factor driving hospital attendance and admission. Lengthy waits to speak to appropriate professionals exacerbate parental anxiety and can trigger direct attendance at ED, whereas some children with complex needs had direct access to convulsion professionals. Conclusions SSAs for convulsions are different to SSAs for other conditions and our findings could inform new efficient convulsion-specific pre and post hospital pathways designed to improve family experiences and reduce admissions and readmissions., Objective To inform interventions focused on safely reducing urgent paediatric short stay admissions (SSAs) for convulsions. Methods Routinely acquired administrative data from hospital admissions in Scotland between 2015- 2017 investigated characteristics of unscheduled SSAs (an urgent admission where admission and discharge occur on the same day) for a diagnosis of febrile and/or afebrile convulsions. Semi-structured interviews to explore perspectives of health professionals (n = 19) making referral or admission decisions about convulsions were undertaken. Interpretation of mixed methods findings was complemented by interviews with four parents with experience of unscheduled SSAs of children with convulsion. Results Most SSAs for convulsions present initially at hospital emergency departments (ED). In a subset of 10,588 (11%) of all cause SSAs with linked general practice data available, 72 (37%) children with a convulsion contacted both the GP and ED pre-admission. Within 30 days of discharge, 10% (n = 141) of children admitted with afebrile convulsions had been readmitted to hospital with a further convulsion. Interview data suggest that panic and anxiety, through fear that the situation is life threatening, was a primary factor driving hospital attendance and admission. Lengthy waits to speak to appropriate professionals exacerbate parental anxiety and can trigger direct attendance at ED, whereas some children with complex needs had direct access to convulsion professionals. Conclusions SSAs for convulsions are different to SSAs for other conditions and our findings could inform new efficient convulsion-specific pre and post hospital pathways designed to improve family experiences and reduce admissions and readmissions.

Background: End-of-life care for children with life-shortening conditions is provided in a range of settings including hospital, hospice, and home. What home-based, end-of-life care should entail or what best practice might look like is not widely reported, particularly from the perspective of parents who have experienced the death of a child at home. Aim: To explore the value and assess the effectiveness of an innovative, home-based, end-of-life care service as perceived by families who accessed the service. Design: An qualitative, descriptive design involving in-depth interviews with bereaved parents and thematic framework analysis. Setting/participants: 13 bereaved parents of 10 children supported by the service at the end-of-life. Results: Parents reported effective aspects of end-of life care provided at home to include: 1) ability to facilitate changes in preferred place of death; 2) trusted relationships with care providers who really know the child and family; 3) provision of child and family-centred care; 4) specialist care and support provided by the service as and when needed; and 5) quality and compassionate death and bereavement care. Whilst parents typically did not use the term ‘anticipatory care planning’ in their interviews, they spoke of the initial and ongoing conversations with staff which underpinned and informed end-of-life care. Conclusion: Parents with lived experiences of caring for a dying child at home offer valuable input to future policy and practice of effective home-based, end-of-life care of children including the essential role of anticipatory care planning and recommendations for shared learning, improving access, and dispelling hospice myths.

Problem: There is a growing international drive to deliver children’s palliative care services closer to home. Families should have choice of where end of life (EOL) care is provided with home as one option. This review aims to establish the current international evidence base relating to children’s EOL care at home. Eligibility Criteria: A systematic scoping review was conducted in accordance with PRISMA-ScR reporting guidelines. Seven databases were searched to identify papers published between 2000-2018. Eligibility criteria included papers reporting children’s EOL care with specific relation to: home being the preferred place of death; services providing EOL care at home; family experiences of receiving support when their child died at home and professionals’ experiences of delivering this care. Sample: Twenty-three papers met the eligibility criteria and were included in the review. Results: Engagement of families in EOL care planning discussions was identified as a key factor to facilitate choice of setting. Consistent themes from the data suggest that providing access to care in the home 24/7 by a team of professionals with specialist paediatric palliative care knowledge is an essential aspect of any model of home-based EOL care. Discussion and Application to Practice: This is the first comprehensive review of home-based EOL care for children which offers a valuable contribution to policy, practice and research. The evidence mapped and synthesised in this review can inform the development of services to facilitate the provision of EOL care at home in line with the unique wishes and needs of children and families.

The wellbeing of care home staff and the need to support them at work was highlighted with devastating clarity by the COVID pandemic. This small study explores what online and at work wellbeing resources were available to frontline care home workers during the first wave of the pandemic. A mixed methods study was undertaken May and July 2020. A multi-disciplinary team undertook a rapid review of online wellbeing information and resources relevant specifically to the care home sector and its non-nurse staff. Qualitative data comprised of digital recordings of semi-structured interviews with six care home managers of five care homes, and an online survey sent to 55 Scottish care homes with a response rate of 18%. Five overarching lessons were identified from the data. The first two (‘managing information overload’ and ‘medium not appropriate for the message’) relate to the awareness and use of the online wellbeing resources by frontline care workers. Three others (‘visible and supportive leadership’, ‘building team camaraderie’ and ‘maintaining a focus on wellbeing beyond a crisis response’) highlight the in-house, practice-based issues of supporting the wellbeing of staff. Although small, the findings from this study are of relevance and use by those in the UK and beyond working develop and sustain more effective ways to support and retain of this vital workforce.