Aim Unnecessary attendances to Emergency Departments with primary care presentations are rising, causing increasing strain financally and operationally on the NHS. The concept of hospital avoidance has long been on the agenda by attempting to establish alternative primary unscheduled care models to manage demand. This study evaluated episode trends from those referred to a community paediatric nurse led, acute hospital admission avoidance service to present an overview of the service users and outcomes. The service, based in the Wessex region, takes referrals for children aged 0–16 years from GP’s, GP Out Of Hours, Walk in Centres and the ED at the local District General Hospital. Referrals are received under ten high volume conditions that often do not require acute hospitalisation but historically have contributed to high unscheduled admission rates.
Methods A retrospective cross sectional quantitative design of routinely collected data was used. Descriptive data was compared longitudinally over two separate years from 2013–14 (Period 1 n=1369) against findings from 2015–16 (Period 2 n=1229).
Results A reduction in mean visits by the service from Period 1 (0.88) to Period 2 (0.55) ( p<0.05) indicate greater support and advice given via telephone. Length of stay also reduced from a mean in Period 1 of 3.308 days to 3.3155 days in Period 2. Peak referral times were 10.00–14.00 and 16.00–19.00 from all sources. Four distinct postcode areas, consistent across Period 1 and 2, were interestingly not areas of highest deprivation.
Illnesses presenting to the service from GP/Urgent care were predominately viral respiratory (58.1% Period 1, 58.9% Period 2) and gastroenteritis (15.1% Period 1, 13% Period 2).
GP Out Of Hours referrals (4.7% Period 1, 5.5 .% Period 2) were consistently low.
Emergency Department referrals (18.4% Period 1, 22.1% Period 2) increased, while GP referrals decreased, highlighting a concerning 8.1% shift.
Conclusions Illness presentations locally mirrored national trends. Increased attendance at ED with primary care illnesses, variations in postcode and socioeconomic status highlights the need for further work to establish factors motivating health seeking decisions. Increased efficiency was demonstrated in Period 2 through a reduction in length of stay and home visits for assessment, suggesting these episodes, could safely and effectively be managed via telephone support.
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