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G329 Modelling the potential impact of new out-of-hospital (OOH) models of care on paediatric emergency department (ED) presentations
  1. RM Viner1,2,
  2. F Blackburn2,
  3. F White2,
  4. S Nelson2,
  5. T Parr2,
  6. F Cleugh3,
  7. C Lemer4,
  8. M Watson3,
  9. D Hargreaves1
  1. University College London Great Ormond Street, Institute of Child Health, London, UK
  2. Children and Young People’s Programme, Healthy London Partnerships, London, UK
  3. Imperial College NHS Trust, London, UK
  4. Evelina London Children’s Hospital, London, UK


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).

Abstract G329 Table 1

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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