Aims A major component of better integrated care is improving urgent care for children and young people(CYP). However few data are available to guide commissioners/providers in planning OOH models to reduce ED presentations.
Methods Prospective data collection on sequential CYP <18 years presenting to 6 busy EDs across London 10am– 10pm over 14 days(Feb–March 2016). We used a supernumerary clinician to collect data on diagnosis, severity and clinical need for investigations and management. We used algorithms based on clinical need to identify patients potentially appropriately managed in a range of new OOH models. Models were identified from literature and service review(see Table).
Results We obtained data on 3020 CYP (mean age 6.1 year; 0–17.9 years). 95.6% were in segments considered appropriate for the OOH models: transient acute illness, exacerbation of LTC, complex LTC/disability and injury/trauma. 81.9% were either not ill/injured or only mildly ill/injured. Most required assessment by a clinician with skills in assessing illness (39.6%) or injuries (30.9%), with only 2.1% requiring a specialist paediatric opinion and 6.8% requiring other specialists.
The Table shows the potential proportions appropriate for management within each OOH model.
Conclusions New OOH models could have managed 14%–76% of observed paediatric ED presentations. While enhancement of current primary care could potentially manage around one-quarter of ED presentations, an enhanced CYP service across a GP confederation might manage 45% and more comprehensive services could potentially manage 65%–75% of current ED presentations.
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