Abstract

Cow’s Milk Protein Intolerance (CMPI) is one of common childhood food intolerances, with highest prevalence in first year of life, which is resolved by use of appropriate alternate formulae and dietary advice. As symptoms are acute, parents seek immediate medical attention mostly through accident and emergency or GP referrals. This takes up a lot of hospital time thereby increasing wait times for other acute emergencies. As children were reviewed by both doctor and dietician separately, it resulted in increased clinician time, longer waits and parental stress. Root Cause Analysis was carried to understand cause and extent of the problem and there was a lack of an effective pathway in community. Stakeholders were identified and communication plans were set to engage with hospital paediatricians, commissioners and dieticians to highlight problems and discuss solution for the problems. I facilitated a workshop on devising a community clinic pathway. The analysis was disseminated through presentations, case studies, process maps defining the current and future state. The objective was access of multidisciplinary healthcare services for CMPI involving Paediatrician, dietician and clinic nurse in the community to improve quality of care and reduce wait times and hospital admissions, typically within 2 weeks of referral, supported by post clinic “Dietician led parent groups”. The implementation of change was done in 18 months which included designing the new pathway, training the staff and unifying prescribing practice. I formulated the referral criteria to these clinics as per NICE guidelines. Both GP and Hospital referrals were diverted to these clinics. Feedback of the service were through patient feedback forms and clinical governance meetings. We measured the effect of change through audit over the year, which indicated 54% reduction of doctor time, as they were followed up by dieticians and only 12% onward referral to hospital specialists.