Before Arrival at Hospital (BeArH) project

The BeArH project plans to retrospectively identify organizational and environmental factors and individual child, family and professional factors affecting timing of admission to hospital for children with serious infectious illness (SII) in Leicestershire and North Northamptonshire. 

Infection is a major cause of childhood deaths in the UK and globally, particularly in the first five years of life, yet little is known about factors influencing children’s journeys to hospital with a serious infectious illness. 

Many of these deaths are avoidable as infections such as pneumonia and meningococcal disease are amenable to treatment if provided in time. According to Health Protection Agency Data, infectious illness in childhood constitutes approximately 50% of children’s GP consultations and 12% of children’s hospitalisations. It is often difficult for healthcare professionals to determine whether or not a child is seriously ill at first presentation consequently it should not be surprising that parents also find it difficult to interpret symptoms and know when to consult.
Given the lack of research exploring the pre-hospital pathways of children with an infectious illness, identification of all modifiable steps in the child’s journey to hospital admission is urgently needed so that evidence-based solutions can be developed. Effective interventions will reduce NHS costs associated with treatment, hospital admissions and litigation (the cost of failure or delay in diagnosis was estimated to be over £20m in legal settlements during 1999–2011).

The primary outcome will be a grounded theory which:

• identifies child, family and professional factors affecting the timing of admission to hospital for children with SII in two contrasting areas
• explains family and professional decision making for children with SII pre-hospitalisation
• identifies human factors influencing families and professionals in primary/secondary first contact health services for children with SII
• identifies environmental and organisational modifiable factors
These findings will form the basis for intervention design and the feasibility study to follow, designed to optimise the timing of presentation to hospital of children with SII. Effective interventions would be expected to reduce morbidity, mortality, family distress, NHS costs associated with treatment, hospital admissions and litigation.

Principal Investigators: Professor Sarah Neill and Mrs Sue Palmer-Hill

Research team:

Professor Sarah Neill, University of Plymouth
• Professor Bernie Carter, Edge Hill University and Alder Hey Children’s Hospital
• Professor Enitan Carroll, Alder Hey Children’s Hospital and University of Liverpool
• Dr Amardeep Heer, Research lead and GP, Lakeside Healthcare Corby
• Dr Damian Roland, Paediatric Emergency Care Consultant, Leicester Royal Infirmary and University of Leicester
• Dr Poornima Pandey, Paediatrician, Kettering General Hospital Foundation Trust
• Sue Palmer-Hill, Research and Development Manager, Northamptonshire Healthcare Foundation Trust
• Joanne Hughes, founder Mother’s Instinct
• Lucie Riches, Community Support Officer, Meningitis Now
• Dr Kim Woodbridge-Dodd, University of Northampton
• Natasha Bayes, University of Northampton.