Patient scenarios

Ben’s story

Ben, two, lives near Leyburn and has had a slight cold for a couple of days. By Monday afternoon he has developed a high fever, stiff neck and has a rash which his mum is worried about and rings for an urgent GP appointment. The GP, who sees Ben, is also concerned and suspecting meningitis, gives the appropriate medication of penicillin and rings 999 for an ambulance.

What happens next

Ambulance

The ambulance takes Ben to the nearest hospital – Darlington Memorial Hospital – where he has blood tests and receives the appropriate fluids and antibiotics. The doctors and nurses feel that Ben is seriously unwell and needs paediatric intensive care, so they phone the paediatric intensive care unit in Newcastle who send their specialist team to collect him. After a few days in intensive care, Ben is recovering well and returns to Darlington for daily antibiotics. After a couple of days in hospital, Ben is discharged home and receives his last two days of antibiotics at home, near Leyburn, given by a children’s community nurse. Ben is offered follow-up with one of the local paediatric consultants at a clinic in Catterick.

Sarah’s story

Sarah, six, lives in Thirsk. Over the weekend she had developed red swollen knees and her mum makes an appointment to see her GP on Monday morning, who suspects Sarah may have arthritis.

What happens next?

Child on scales

The GP phones the short-stay paediatric assessment unit (SSPAU) at the Friarage Hospital and makes an urgent appointment for Sarah to be seen there that day by faxing a referral letter. Sarah is offered an appointment in the afternoon and when she arrives on the unit, she is met by a nurse, weighed, measured and anaesthetic cream applied. She sees a consultant who suspects Sarah has reactive arthritis and an ultrasound scan is arranged as an outpatient. A member of nursing staff also takes bloods and suitable pain relief is prescribed and given. Sarah is also referred to a physiotherapist at the children’s centre and an outpatient appointment is made in the specialist rheumatology clinic. Sarah is seen four weeks later in the rheumatology clinic, where the scan and bloods indicate she has juvenile arthritis so a specialist review is needed. Sarah is referred to the service in Leeds and will be seen twice a year in Leeds and twice a year in Northallerton.

Sam’s story

Sam, eight, from Northallerton has seen the GP with his mum after having a second spell of wheezing. The GP isn’t happy and decides he needs a paediatric assessment and a period of observation.

What happens next?

Boy respiratory test

The GP phones the short-stay paediatric assessment unit at the Friarage Hospital and faxes in a referral. Sam arrives on the unit at midday and is assessed and observed by a children’s nurse. He is seen by a junior doctor and a diagnosis of possible asthma is made. Treatment is given with regular inhalers and steroids and by 4pm, Sam is much better and after seeing a consultant goes home. The next morning, Sam’s mum is still worried and wonders if he is wheezy again. Sam has been given three days open access to the short-stay assessment unit at the Friarage Hospital, so his mum phones the unit and brings him in. He is assessed again and given further inhalers but doesn’t respond particularly well to treatment and after two hours, it is decided he needs to be admitted to hospital. As there is no inpatient (overnight) children’s ward at the Friarage Hospital, Sam is transferred to The James Cook University Hospital in Middlesbrough by ambulance with his mum, where he receives regular inhalers and some overnight oxygen. Sam’s mum stays with him on the ward and after 24 hours, he is fit for discharge and allowed to go home, with a review arranged the following day in the short-stay paediatric assessment unit at the Friarage Hospital. After speaking to Sam’s mum it is clear he has had problems with his breathing for the past few months that have been difficult to manage, so he is offered a follow-up appointment at the specialist respiratory clinic at the Friarage Hospital.

Oliver’s story

Oliver, three, lives at Catterick Garrison but his dad is currently posted abroad. He has been struggling to open his bowels for a number of weeks and has stomach pain so his mum takes him to the GP. The GP is worried Oliver is constipated and also that he is developing a long-term problem because he has previously received treatment by another GP.

What happens next?

NHS REFRESH

The GP phones the short-stay paediatric assessment unit at the Friarage Hospital and faxes in a referral. Oliver is offered a review on the unit and when he arrives, he is met by one of the nursing staff, weighed and measured. The junior doctor examines Oliver and confirms constipation. After a discussion with the consultant, Oliver is given some strong laxative and kept on the unit for observation. He had a good result from this and is discharged home later that day on regular medication. The following week, one of the nursing staff telephone Oliver’s mum to see how he is doing and he has a follow-up appointment two weeks later in the community-nurse follow-up clinic. He attends a consultant follow-up appointment 12 weeks later at Catterick.

Patient scenarios booklet(2mb)
In order to view PDF documents you will need Adobe PDF Reader