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G211 To GP or not to GP: evaluation of children triaged to see a GP in a tertiary Paediatric Emergency Department
  1. L Smith1,
  2. Y Narang1,
  3. K Edwardson2,
  4. A Cumbers3,
  5. S Bowers4,
  6. K Jones5,
  7. E Carrol6,7,
  8. M Ryan8
  1. 1School of Medicine, University of Liverpool, Liverpool, UK
  2. 2Information Department, Alder Hey Children’s Hospital, Liverpool, UK
  3. 3Business Intelligence, Urgent Care 24, Liverpool, UK
  4. 4Paediatrics, Liverpool CCG, Liverpool, UK
  5. 5Urgent and Community Care Services, Urgent Care 24, Liverpool, UK
  6. 6Infectious Disease, Alder Hey Children’s Hospital, Liverpool, UK
  7. 7Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
  8. 8Emergency Department, Alder Hey Children’s Hospital, Liverpool, UK

Abstract

Background Reports suggest that up to 40% of attendances to Emergency Departments (ED) are not appropriate for hospital care, with consensus that this problem may be more prevalent in paediatrics. It has been suggested that options to cope with rising ED attendances are to either restrict the use of ED services or to adapt to an expanded role of the ED; providing services to cater for all attendees; whether they be considered ‘traditionally ED appropriate’ or not.

Aim The aim of this study was to evaluate the effectiveness of a CCG-funded GP service within a tertiary paediatric ED setting, compared to ‘traditional’ care by the ED.

Method Participants were children (n = 5374) attending Alder Hey ED triaged ‘green and GP appropriate’, from 1 October 2014 to 31 March 2015. The intervention consisted of a new care pathway that placed a GP into the ED, (1400–2200, 7 days/week) and allocation of children by triage to either the GP or ED doctor depending on whether there was a GP available in the ED. The main outcome measures were; discharge status, duration in department, GP to ED referral rate.

Results A total of; 3203 were seen by GP, 2171 by ED. Median duration of stay in ED was 90 mins for GP versus 117 min for ED doctor, p < 0.0005. Of patients seen by GP; 183 (6%) were referred to ED for further intervention. A total of 854 (30%) of children seen by the GP received antibiotics compared to 399 (19%) seen by an ED doctor, p < 0.0005. Patients seen by a GP were 79% less likely to leave the ED prior to the receipt of treatment, compared to those who were treated via the ‘traditional’ ED care pathway.

Conclusions Our pilot study suggests that non-urgent ED attendances are more effectively handled by adapting to an expanded role of ED through provision of integrated Primary Care services rather than attempts to change health seeking behaviour of service users.

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