Aims Our hospital serves a population of 300,000 that is characterised by high ethnic diversity and a large percentage of under 16 year-olds. Currently GPs have only two options when referring a child: telephone request for same-day (AE) assessment, or referral to the outpatient department (OPD) with an 8 week wait. In order to improve rapid access to specialist Paediatric opinion without further burden on A&E we sought evidence to support a change in service provision.
Methods Evidence was gathered by surveying 3 domains in November 2014:
Outpatient referrals: 2 Paediatric consultants reviewed 48 sequential GP referrals to categorise the clinical category (eg respiratory) and assess whether they could have been alternatively managed in the community.
The on-call team logged all emergency GP calls received on a proforma, noting clinical category, urgency and patient outcome (eventual hospital admission or not)
Local GPs were surveyed regarding their satisfaction with current services including ease of access to advice and potential for improvement.
10 OPD referrals (21%) were identified as being inappropriate or avoidable.
95 patients were referred to the on-call team. In 15 cases (16%) advice alone was given. Of the 73 patients assessed in AE, 36 (49%) were reviewed and discharged with no investigations.
30 local GP practices were surveyed. Average satisfaction score with speed of OPD assessment was 6.5 (1–10 scale). 28 practices stated they would benefit from a telephone advice service. GPs estimated taking over 5 min to connect to the on-call registrar by telephone bleep system.
Conclusion Our results identified high referral rate to AE for children who did not need admission. There was poor satisfaction among GPs with speed of outpatient review and delay in speaking to the on call Paediatric registrar. Using these results we identified a need for improved access to Paediatric advice which might then reduce ED attendances and OPD referrals. We used this data to propose a Paediatric consultant-led telephone advice service be instituted for GPs. GPs have indicated they would find this beneficial, and it would reduce unnecessary referrals.
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