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Management of non-urgent paediatric emergency department attendances; a retrospective observational study

Leigh, Simon, Mehta, Bimal, Dummer, Lillian, Aird, Harriet, McSorley, Sinead, Oseyenum, Venessa, Cumbers, Anna, Ryan, Mary, Edwardson, Karl, Johnston, Phil, Robinson, Jude, Coenen, Frans, Taylor Robinson, David, Niessen, Louis ORCID: https://orcid.org/0000-0002-8639-5191 and Carroll, Enitan (2021) 'Management of non-urgent paediatric emergency department attendances; a retrospective observational study'. British Journal of General Practice, Vol 71, Issue 702, e22-e30.

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Abstract

BACKGROUND Non-urgent emergency department (ED) attendances are common among children. Primary care management may not only be more clinically appropriate, but also improve patient experience and cost-effectiveness.
AIM To determine the impact of integrating a general practitioner (GP) into a paediatric ED, on admissions, waiting times, antibiotic prescribing, and treatment costs.
DESIGN & SETTING Retrospective cohort study of non-urgent ED-presentations in an English paediatric ED.
METHOD From October-2015-September-2017, a GP was situated within the ED, from 2pm-10pm, seven-days-a-week. All children triaged green using the Manchester Triage System (non-urgent) were
considered ‘GP-appropriate’. In cases of GP non-availability, non-urgent children were managed by ED staff. We compared clinical and operational outcomes, and healthcare costs, of children managed
by GPs and ED-staff over the same timeframe (2pm-10pm), over a two-year period.
RESULTS Of 115,000 children attending the ED over the study period, 13,099 children were designated ‘GP appropriate’, 8,404 (64.2%) managed by GPs and 4,695(35.8%) by ED staff. Median duration of ED-stay was 39min (IQR 16-108) in the GP-group and 165min (IQR 104-222) in the EDgroup(p<0.001). The GP-group were less likely to: be admitted as inpatients (OR 0.16, 95%CI 0.13-0.2) and wait longer than four-hours (OR 0.1, 95%CI 0.08-0.13), but more likely to receive antibiotics (OR 1.42, 95%CI 1.27-1.58). Treatment costs were 18.4% lower in the GP-group, p<0.0001.
CONCLUSION Based on retrospective observational data, children seen by the GP in the emergency department waited less time, had fewer inpatient admissions and lower costs, but experienced higher
antibiotic prescribing. Given rising demand for children’s emergency services, ‘GP in ED’ care models may improve the management of non-urgent ED presentations, however further research incorporating causative study designs is required.

Item Type: Article
Subjects: WS Pediatrics > WS 100 General works
WX Hospitals and Other Health Facilities > Clinical Departments and Units > WX 215 Emergency service. Ambulance service
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.3399/bjgp20X713885
Depositing User: Tina Bowers
Date Deposited: 30 Nov 2020 16:17
Last Modified: 06 Apr 2021 13:07
URI: https://archive.lstmed.ac.uk/id/eprint/16238

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