Cutting child deaths from treatable infections

An 18-month study will investigate concerns raised by Melissa Mead and Sue Morrish, who both lost sons to sepsis after high profile failures in the health system.

‘Before Arrival at Hospital: Factors affecting timing of admission to hospital with serious infectious illness (BeArH)’ has received £147,000 funding from the NIHR, the research arm of the NHS, and will run until May 2019. Several other charities are also supporting the research, including the UK Sepsis Trust, the Meningitis Research Foundation, WellChild and the Encephalitis Society.

Led by the University of Northampton, the BeArH research project will examine in detail, incidents of serious infection in children under five years of age – from the moment a parent realises their child is ill, through contact with frontline health services, to their child’s subsequent admission to hospital.

The UK has more childhood deaths from treatable infections than comparable European countries, and new research will investigate why fatal delays in hospitalisations occur. Sweden and Italy both have better survival rates from conditions such as pneumonia and sepsis, and the hope is this project will identify ways to speed up admissions, and ultimately save lives.

The research aims to identify those points in this process where improvements can be made. Associate Professor of Children’s Nursing, Sarah Neill, is leading the NIHR-funded project along with Dr Amardeep Heer from Lakeside Healthcare, the largest general practice in the NHS.

 “Infection is a major cause of avoidable childhood deaths in the UK, particularly in the under-fives, yet we know little about the factors that influence when children are admitted to hospital.” Dr Neill, University of Northampton

These factors may range from aspects of individual children and their family situations, through to the responses of GP surgeries, NHS helplines or A&E departments. Many of these deaths could be avoided, as infections such as meningitis and pneumonia are potentially treatable if caught early enough.Parents often find it difficult to access relevant health information or to interpret symptoms. It can even be difficult for GPs to determine how serious a case is in the early stages.

“Identifying all the steps before hospital admission that could be improved is vital if we are to spare other families the heartache that Melissa and Sue have had to go through.”

Twelve-month-old William Mead died from blood poisoning in 2014 after both the NHS 111 helpline and GPs failed to recognise his condition. Sam Morrish was three years old when, in 2010, he too died from sepsis in what the official report called “a catalogue of errors” by the health services.

This project will be examining every stage in the child’s journey to see where delays may occur. This might be due to lack of easily accessible, reliable information for parents on symptoms, errors in information sharing between different parts of the NHS, or delays in being seen in an emergency department. Whatever it is, the information we gather will help us to design service improvements so that children get the help they need more quickly. Data for this study will be collected from the catchment areas of the hospitals participating in the study.

The project has three strands – the first will look at the health services available to parents in each area, and review investigations into previous cases of serious infection – including child death reviews, critical incident reports, and hospital and ambulance usage data.

The next will involve specially trained nurses identifying parents of children being cared for in high dependency or intensive care with a serious infection

Once their child is well enough to move to a children’s ward, the parents will be approached to take part in the study and interviewed once their child is home again. With parent’s permission, health professionals involved in their child’s pre-hospital care will be interviewed separately, to get a fuller understanding of the child’s journey to hospital.

The final strand will involve focus groups with parents whose child had a serious infectious illness in the last two years, as well as separate focus groups with healthcare professionals who’ve had experience of caring for such children.

All of this data will be combined to produce a theory which explains how identified factors affect the point at which ill children are admitted to hospital.

Findings from this project will identify where services need to change. The next project will work with parents and health services to make these changes and evaluate the impact.