With ‘Dr Dog’ on the ward, The Giggle Doctors making the children laugh out loud and a helter-skelter slide, Evelina London Children’s Hospital sounds more like a fun-filled theme park than a place of healing. But as consultant anaesthetist Dr Caroline Davies explains, the entertainment is just one aspect of a standard of paediatric care that is one of the best in the country.
Once a week, Magee and Nala visit Evelina London Children’s Hospital. They’re not relatives of a sick child, or hospital staff turning up for a shift. In fact, Magee is a soft fluffy Cockapoo and Nala is a gentle Golden Retriever and while their presence on the wards may not heal the physical injury of Evelina London’s sick inpatients, it has tremendous benefits for the children and their parents.
Magee and Nala are specially-trained therapy dogs from Pets as Therapy who love to be stroked and cuddled – perfect for a sick child who craves animal company and misses their pets back home.
On the days when the dogs are absent, it might be that bedbound patients get a visit from The Giggle Doctors, a clown-based troupe who tell jokes and do magic to cheer up those at a low ebb.
The hospital building itself on the site of St Thomas’ Hospital was designed especially for children and with the help of children. It first opened its doors 10 years ago. Already, Evelina London has become known for its philosophy of creating an environment that does as much as possible to ease the stress of serious illness on the young and fragile.
But underpinning that, as consultant anaesthetist Dr Caroline Davies explains, is a culture of high-quality care that ensures Evelina London boasts, among other things, some of the best neonatal survival rates in the UK, a kidney transplant service that accounts for a fifth of all UK paediatric kidney transplants and a roll-call of around 55,000 young patients a year.
The result? An ‘outstanding’ verdict from the Care Quality Commission. ‘That was a marvellous boost for every member of Evelina London’s staff,’ says Caroline.
Staff at Evelina London are doing outstanding research, developing top notch services and introducing all sorts of innovations to optimise patient care.’ Excellent clinical care aside, the sheer scale of the planning and design that went into building Evelina London was breath-taking. But that careful planning is paying off.
One example is the built-in school for children.
‘The hospital school is brilliant,’ says Caroline. ‘The children seem to love it, even when they are quite poorly. ‘It is fantastic because it distracts them, entertains them, helps them keep up with their schooling and gives them some normality and routine during their hospital stay.’
‘For children that can’t get downstairs to school, a teacher may visit them on the ward, to sit and read with them.’
The deployment of play specialists also has a major impact.
Caroline says: ‘They are crucial because they help to distract children who may be feeling anxious and upset and they are a huge help to us anaesthetists when patients are anxious or may have challenging behaviour when they come to theatre.
‘A Play specialist will often come down with very anxious children into the anaesthetic room and they are very good at gauging what sort of toys or games will captivate a certain child and how to distract them during the induction of anaesthesia.
‘Then there are the lovely visiting musicians who play and sing on the wards. The atmosphere feels happy and relaxed. There is a lot of commotion but in a good way! It’s a good way to help the children to pass the day.’
Evelina London is part of Guy’s and St Thomas’ NHS Foundation Trust. Among other things it features 161 inpatient beds (including 20 intensive care beds), a 51-cot neonatal unit, five operating theatres and one cardiac theatre.
There is a full children’s imaging service with MRI scanner, x-ray and ultrasound, a kidney dialysis unit, an outpatient’s department and a medical day care unit. It most definitely is a hospital – just built not to look or feel like one.
For example, inpatients are deliberately housed near the top of the seven-storey building – so they get the best views of Lambeth Palace and Archbishop’s Park. And the building is themed around the natural world so that the ground level represents the sea, the top floor the sky. Everything, it seems, is geared towards keeping patients as happy as possible. ‘And that’s important,’ says Caroline. ‘If children have a positive experience during their admission, it will provide a good foundation for future hospital visits.
‘If a child has a chronic medical condition, they are probably going to come into hospital quite a lot. So, it is very important to give them the best experience you can and make it feel as homely, safe and friendly as possible.’
Pain control, Caroline’s speciality, is also crucial in this respect. She says: ‘People may not always remember much about their hospital stay, but they are more likely to remember it in a negative way if they experienced a lot of pain. ‘One of the most important factors for parent and child satisfaction with their hospital stay is good pain control ‘
But every child is different. It can be quite difficult assessing pain in, say, a 12-year-old child with severe learning difficulties. ‘We have a variety of pain assessment tools that we can use for children who can’t communicate verbally and we try to involve parents and carers as much as possible.’
But as Caroline admits, there are challenges when treating a wide age range – from tiny babies to teenagers. ‘We have to ensure that each child’s method of pain relief is tailored specifically to their needs and also managed safely on the ward by the nurses caring for them.
‘We have very clear protocols and guidelines to aid clinical staff caring for our patients. Training is a constant theme and is essential to enable nurses to assess and manage pain in children of all ages.
‘Evelina London is quite small and one of its strengths is that you can liaise with other staff very easily.
Evelina London is able to utilise the vast knowledge and expertise of its staff as it evolves.
One popular initiative is its regular Dragons Den-style sessions, where staff can pass on their ideas about how to improve things. She adds: ‘It is about encouraging people to focus on ways to make things better in every area of patient care. Everyone feels they have a voice and that is very important.’
by Pat Hagan