A 5-year analysis of wheezy children managed by the children’s ‘Ambulatory Care Experience’ team at Bradford Royal Infirmary (BRI)

<bold>Introduction and Objectives:</bold> The Ambulatory Care Experience (ACE) model is a first of its kind in the UK, providing specialist nursing care at home for unwell children who would ordinarily be referred to hospital. The wheezy child referral pathway exists for children with mild to moderate wheeze. In addition to acute management, the team deliver a ‘care bundle’ including inhaler delivery support, education in managing future episodes, identifying triggers and smoking cessation advice. Our primary objective was to assess whether children with mild to moderate wheeze can be managed safely in the community. <bold>Methods:</bold> Data was collected prospectively from 01/12/2017 to 31/12/2022 and subsequently analysed. 1234 referrals were received of which 1028 were accepted <bold>Results:</bold> Of the 1028 referrals, 1000 children were seen by ACE and 28 by acute care paediatricians. 57% of referrals were from primary care or ED and 43% from hospital paediatricians. Of those children seen, 86% remained at home, 13.5% were sent to an acute paediatric ward and 0.4% were sent directly to ED due to deterioration. All patients received holistic support resulting in 46% of parents agreeing to flu vaccination and 21% of patient carers receiving smoking cessation advice. After implementation of the ‘care bundle’, nearly half (48%) of children never re-presented or required hospital admission during the 5-year period. <bold>Conclusion:</bold> This analysis demonstrates children with mild to moderate wheeze can be safely managed in the community with nurse support and escalation to hospital care if necessary. We have demonstrated that with adequate resources, there has been a significant drop in the number of children requiring acute care. Appropriate education prevents nearly half of children from representing to hospital.