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Boosting child health through simplified diagnostics

Dr Hilary Cass, member and former president of the Royal College of Paediatrics and Child Health, talks to NHE about the progress and aims of a new tool created to improve the entire child healthcare journey.

Paediatric Care Online (PCO UK), which brings together the input of GPs, nurses, pharmacists, health visitors and hospital doctors, is striving to become the most comprehensive and wide-reaching tool for improving childcare. 

Inspired by a similar development in America and commissioned by the Department of Health, the online tool was designed to reduce mortality rates and tackle delays in care by translating an array of existing guidelines, policy and formulary into simplified guidance for treating children. 

Unlike guidance from NICE or that in the Green Book, PCO UK sets itself apart by starting from the point of first contact with a health professional, not the condition. It is shaped around symptoms – of which there are more than 100 in the evolving tool – rather than the final diagnosis, allowing any health staff, regardless of qualification level, to seamlessly pinpoint what the problem might be. 

Quick access to symptoms, referrals and tests 

Dr Hilary Cass, clinical lead for the project and member of the Royal College of Paediatrics and Child Health (RCPCH), said the ultimate ambition was to create a one-stop shop for paediatrics in an organic platform. Because it was designed “from the other end”, starting from point of contact rather than distilling large textbooks on illnesses, she said the guidance is now extremely tight – meaning time-pressed GPs can access key points within a couple of minutes using the tool’s integrated search facility.

“Because of the way it’s laid out, you can rapidly get to what the red flags are for a symptom, when you should refer the child to the hospital, and what tests you need to do to get to the diagnosis,” Cass said. “So a GP with a 10-minute consultation can get that information really fast without actually having a diagnosis.” 

No need for specialised training 

Cass said the RCPCH wanted to ensure any healthcare professional is equipped with the necessary information to treat any child they need to. “Quite often you might have a surgical junior doctor who’s looking after a child who is breathless, and they’re very much going to need this sort of information,” she explained. “If they’ve got a child in front of them, they have to be just as competent. We wanted to prioritise that above the much more in-depth information for a paediatrician who’s been in the business for a number of years and wants to learn more about the condition. We thought we’d come onto that later – first, we needed to make kids safe the minute they’re first contacted by a professional.” 

This is particularly relevant for GPs, given that the first point of contact for children in the UK is in generalised primary care rather than specialised paediatrics. According to Cass, only about half of GPs actually receive dedicated paediatric training or a paediatric placement, so it can be “quite scary” if they are confronted with a sick child early in their career. 

Input from the entire workforce 

Cass said the input of paediatricians was absolutely crucial during PCO UK’s development. But it was the help of GPs, nurses, health visitors, pharmacists and medical trainees that really helped shape the programme into a highly accessible and inclusive piece of work. 

“It’s no good if you have guidance written just by paediatricians for GPs to access,” she said. “It’s been really key that we’ve had GP input in the development, because they need to tell us what it’s like from their end – otherwise the way you’d describe how to handle it might just not be as effective in general practice.”

Nurses were also vital to “reality check” the information to ensure it made sense in their role, she said, while pharmacists were asked to check all the drug information, and health visitors analysed immunisation information against the Green Book. 

“We’ve basically had the Royal College of Nursing, health visitors, medical trainees, the Royal College of GPs, paediatricians and pharmacists in a steering group. As well as being involved in developing the guidance, they’ve been involved in the strategy of what we should put on next, because it’s quite complex and a huge task to get everything on. They’ve helped us prioritise what it is that practitioners at the frontline would need most immediately.” 

The tool is desktop and mobile-enabled and available for any subscription payers or RCPCH members as part of their regular fees.

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