Article Text

G186(P) Why do children return to the emergency department?
  1. S Saroey,
  2. JM Cohen
  1. Department of Paediatrics, University College Hospital, London, UK


Aim To compare the reasons for frequent (5–9) and very frequent (10 or more) childhood attendances to an Emergency Department (ED) as part of a collaborative Clinical Commisioning Group (CCG)-wide quality improvement project.

Methods Retrospective audit of electronic records of frequent and very frequent paediatric ED attendances over a 1-year period from September 2013 to August 2014.

Results 11,639 children under the age of 17 years attended the ED resulting in 16,152 attendances between September 2013 to August 2014 (Figure 1).

Abstract G186(P) Figure 1

Breakdown of number of attendances

80 children were frequent attenders (5–9 episodes, total 403 attendances) and 5 children were very frequent attenders (10 or more attendances, total 61 attendances). Within these two groups at least 82% and 97% attendances were non-trauma/illness related in the frequent and very frequent attenders respectively. At least 62% episodes in the frequent and 39% episodes in the very frequent attenders group could possibly have been managed in primary care (Figures 2 and 3).

Abstract G186(P) Figure 2

Percentage of episodes manageable in primary care (5/year cohort)

Abstract G186(P) Figure 3

Percentage of episodes manageable in primary care (10/year cohort)

Conclusion Albeit the limitations of the study given the small number of patients, our findings suggest that a large proportion of paediatric ED workload consists of patients who may have been managed in primary care particularly those who were frequent attenders. The frequent attender diagnoses mirror previous data on overall attendances; which is very heavily biassed by those coming just once, whereas the very frequent attenders represent a cohort much of which is not amenable to primary care treatment. Those that attended very frequently more commonly had chronic underlying conditions and were less likely to present inappropriately. Hence focusing efforts on the frequent rather than the very frequent attenders may be a more effective and profitable approach. Larger prospective studies involving multiple trusts and taking into account patients' reasons for attendance may help to better understand and plan acute as well as integrated services.

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