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Welcome to the ACE Service

Wheeze
Newly-Diagnosed Type 1 Diabetes*
Gastroenteritis
Jaundice*
Croup
Bronchiolitis

* Referrals to the neonatal jaundice and newly-diagnosed type-1 diabetes pathways are currently only being accepted from the children’s inpatient unit at BRI

Thank you for visiting the ACE Service! If you’re new to the service, please take a look at the short films on the right to find out more.

The ACE (Ambulatory Care Experience) Service provides an alternative to hospital referral or admission for children and young people with common acute illnesses like asthma.

Children and young people (CYP) can be referred to the service from Primary Care, as well as the Accident and Emergency Department and Children’s Clinical Decision Area at Bradford Royal Infirmary (ward 32).

Virtual ward

CYP who meet pathway criteria are looked after at home under the care of a nurse and on-call consultant paediatrician in a ‘virtual ward’. The paediatrician takes clinical responsibility for the CYP from the time of referral.

If you would like to refer a child who meets pathway criteria, please click on the relevant pathway icon at the top of this page and follow the referral crib sheet. For assistance please call us on 01274 273354 between 8:30am-8:30pm seven days a week.

Doctors and ANPs in secondary care who wish to refer a child onto one of these pathways should use the relevant icon above and follow the referral crib sheet.

* Please note: Bronchiolitis and neonatal jaundice pathways have recently been added to the ACE Service. Referrals onto these pathways can currently only be accepted from the children’s inpatient unit at Bradford Royal Infirmary (Ward 30).

HSJ Award winner

The ACE Service initially launched as a 12-month pilot project in December 2017, but is now fully funded. Less than a year later, it topped the prestigious Urgent and Emergency Care category at the 2018 HSJ Awards.

If you would like to know more about what a family and patient think about our service, please watch our films featuring mum Tahira (centre) and patient Malaika (bottom) on the right of the page and/or contact us.

The ACE service is YOUR service. You can influence our development so please feel free to provide feedback at any time.  Email us here.

We are also on Facebook and Twitter. We look forward to hearing from you!

What is ACE? Watch our short films to find out more

Who does the service belong to and how does it work?

If you are a Bradford GP, ACE is a service your surgery can offer. It is your service.

ACE is the result of a collaboration between GPs, the local clinical commissioning group (CCG) and Bradford Teaching Hospitals NHS Foundation Trust. We are committed to the following vision:

‘The key to delivering effective and urgent care is ensuring that the whole system is designed to support self-care and community care at home, thereby reducing avoidable hospital admissions and facilitating timely early discharges.’

Institute for Innovation and Improvement

The service is the first of its kind in the UK and provides specialist nursing care at home for unwell children and young people who would ordinarily have been referred or admitted to hospital.

Referrals into the service are predominantly taken from primary care, but also from Bradford Royal Infirmary’s (BRI) Accident and Emergency Department, and the CYP Clinical Decision Area on ward 32.

ACE is delivered in the community

ACE is delivered in communities throughout Bradford and staffed by children’s community nurses (band 6), who work from 8:30am-8:30pm, seven days a week, 365 days a year.

Once a CYP has been accepted into the service clinical responsibility lies with the consultant paediatrician on call at BRI.

CYP have 24-hour open access to the CYP Clinical Decision Area on ward 32 for the duration of their care. This is usually for up to three days.

Individual clinical pathways

Individual clinical pathways have been developed with GPs, nurse practitioners, nurses, pharmacists and paediatricians and are based on best available evidence, national guidance and local clinical agreement.

If a CYP meets the pathway referral criteria they are accepted into ACE. Referrals are made by phone and electronically via primary and secondary care electronic patient systems.

The ACE nurse makes initial telephone contact with the family within two hours of referral and arranges a home visit – usually within four hours of referral.

At this visit a focused history and assessment is undertaken. Further home visits or telephone reviews are then arranged.

In addition to acute management the team also delivers a care bundle. For asthma/wheeze this includes support with inhaler delivery, monitoring the effectiveness of treatment, education in managing future episodes, identifying deterioration and smoking cessation advice.

Nurses discuss each CYP under their care with the paediatric consultant. Clinical discussions occur between the ACE nurse and consultant at least thee times a day. For further information please see the FAQs section below.

Looking to refer a patient? Here's all you need to know

  • How do I make a referral?

    If you would like to refer a child who meets pathway criteria, please click on the relevant pathway icon at the top of this page and follow the referral crib sheet. For assistance please call us on 01274 273354 between 8:30am and 8:30pm seven days a week.

    Bronchiolitis and neonatal jaundice pathways have recently been added to the ACE service. Referrals on to these pathways can currently only be accepted from the children’s inpatient unit at Bradford Royal Infirmary (Ward 30). Doctors and ANPs in secondary care who wish to refer a child on to one of these pathways should use the relevant icon above and follow the referral crib sheet.

    If you would like to suggest a new pathway please send an email to: ace.team@bthft.nhs.uk

  • What information will I need to provide at referral?

    • Your details
    • Patient details and next of kin (including working telephone numbers)
    • Relevant history
    • Observations: oxygen saturations, heart rate, respiratory rate and temperature
    • Are there any sepsis red flags?
    • Examination summary
    • Activity level of child
    • Your ‘gut feeling’
    • Any recommendations
    • Safeguarding concerns
    • Safety netting advice
    • Referral discussed, ACE information leaflet handed out and consent obtained for referral and sharing of information

  • Who are the ACE nursing team?

    Our community nurses have significant experience of working with children and young people in many different settings including the Accident and Emergency Department and Children’s Ward at Bradford Royal Infirmary, and the Paediatric Intensive Care Unit in Leeds.

    Team Leaders: Eve Malam and Emma Morrison

    ACE nursing team

    Eve Malam

    • Team Leader
    • Children’s nurse with previous experience in paediatric intensive care, complex needs, palliative care, research and public health
    • MSc in Health Psychology
    • Special interest in family-centred care and health promotion
    • ACE Primary Care engagement lead nurse

    Emma Morrison

    • Team Leader
    • 11 years’ experience on the children’s acute medical ward
    • Specialist interest in health promotion and the critically ill child

    Lesley Hannah

    • Children’s nurse with 19 years’ experience working on children’s ward in Bradford and Airedale, and within the Bradford Community Nursing Team
    • ACE Gastroenteritis and Bronchiolitis Pathway lead nurse
    • Special interest in respiratory paediatrics

    Janine Duffy

    • Nine years’ experience in a variety of areas – general medical and surgical, renal, gastroenterology and PICU
    • Croup pathway leader

    Lucy Fletcher

    • 13 years as a children’s nurse, working as a staff nurse on an acute medical ward, an oncology research nurse and specialist asthma nurse
    • Wheezy Pathway lead nurse

    Jessica Coatesworth

    • Six years’ nursing experience working in burns, general medicine and surgery, and hospice care
    • Bronchiolitis Pathway Lead

  • ACE staff

    Other ACE staff

    Clinical lead for ACE and consultant paediatrician: Dr Mathew Mathai

    My name is Dr Mat Mathai and I am clinical lead for the ACE project. Over the last ten years  I have worked with GPs, community nurses and Accident and Emergency colleagues to develop better ways of looking after unwell children and young people in Bradford. Our shared vision is that ‘the key to delivering effective emergency and urgent care is ensuring that the whole system is designed to support self-care and community care at home’.

    The ACE project has been an exciting collaboration between General Practice and Secondary Care that has been a springboard to bridging the gaps between home, community and hospital acute care. I have the great privilege of working with an inspiring team of nurses, doctors, educators, pharmacists, managers, clerical staff and commissioners to develop this new service. We are looking for collaboration with other Trusts and hope to develop stronger links across the region to promote high quality urgent care for our children and young people.

    • Head of children’s nursing and lead for ACE clinical governance: Kay Rushforth
    • Project manager: Emma Morrison and Eve Malam
    • Team administrator: Attia Gilani
    • Clinical educators: Tamlin Walker, Laura Deery and Clair-Marie Clarke
    • Training development: Dawn Hare
    • Specialty doctor in paediatrics: Anne Pinches
    • Pharmacist: Manrita Khatker
    • Clinical commissioning group lead for urgent care: David Tatham
    • Lead commissioners: Louise Atherton and Rashmi Sudhari
    • Pathway development: Dr Mathew Mathai, Dr Anne Pinches, Dr Uma Jegathasan, Dr Helen Berry, Dr Anil Shenoy, Dr Sumera Farooq and Dr David Tatham
    • ACE nurse supervisors: Liz Jones, Vicki O’Keefe, Sharon Popple, Gill Falloon, Dawn Hare, Dr Anne Pinches, and Dr Mathew Mathai
    • A&E ACE leads: Liz Jones and Georgina Hudson
    • Digital editor: Dan Webber
    • Improvement Academy collaboration: Dr John Wright, Beverley Slater, and Dr Emily Cooper

  • How do I access referral crib sheets?

    Crib sheets

    Making a referral from primary care:

    Making a referral from BRI:

  • Care bundles

    ACE nurses will complete a care bundle for each child under our team to ensure our care is standardised and comprehensive. Care bundles for each of our live pathways can be viewed below. Completed care bundles for patients referred to us from primary care will be available for GPs to view on SystmOne once the care episode is complete.

  • Information on the ACE service for parents and carers

    Download the ACE service information leaflet for parents and carers.

  • Pathway specific child, parent and carer information

  • Have you got any publicity materials I can use in my surgery?

    • Download the ACE poster here and print out a copy for your surgery
    • Download this ACE poster to advertise the ACE service to fellow medical professionals

  • Presentations and posters

  • Working with our partners

Feedback and further information

  • Feedback

    If you are a health professional who has used the ACE service, we would be very grateful if you could fill in a short survey to let us know how you found it.

    We have put together three separate surveys for the croup, wheeze and gastroenteritis pathways. Please click on the links below to begin. Thanks!

    Research

The ACE service step-by-step guide. Zac was referred by his GP with wheeze (Hover over each picture to follow his story).

1.)

This is Zac and his mum. When Zac becomes unwell and starts to struggle with his breathing, his mum takes him to his GP.

2.)

The GP examines Zac and diagnoses him with viral wheeze. Zac meets the criteria for referral to the ACE team, so his GP gives them a call.

3.)

While still in the surgery, Zac receives 6-10 puffs of inhaled salbutamol via a spacer device. Safety-netting information is given and Zac and his mum go home.

4.)

Zac is now under the care of the ACE team and the consultant paediatrician. Eve, one of the ACE nurses, gives Zac’s mum a call within two hours of his initial referral to arrange a same-day home visit.

5.)

Eve visits Zac and his mum at home and conducts a full assessment. A short and long-term management plan is put in place. Eve arranges a suitable follow-up – this may be a call later that day or a home visit.

6.)

The ACE nurse completes the wheeze care bundle. This includes checking inhaler technique and reviewing Zac’s wheeze management plan. The care bundle ensures consistency and supports health education and promotion.

7.)

Zac is discharged from the ACE service and avoids a hospital visit! A discharge letter is sent electronically to his GP.