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OC-45 Lessons learnt from the emergency department attendances of children in a general hospital
  1. Ní Chathasaigh CM,
  2. Gorman I,
  3. Stokes HS,
  4. O’Neill MB
  1. Paediatrics Department, Mayo University Hospital, Castlebar, Co. Mayo, Ireland

Abstract

Background and aims Attendances of children with their parents at Emergency Departments continues to rise despite the presence of robust primary care services and primary care on call services. This study explored parental expectations and experiences of their ED visit.

Methods This cross-sectional study was developed to explore parental expectations and perceptions of their ED visit. The survey was pretested and refined based on the feedback of 15 parents and carried out over six weeks. Data obtained included child’s age, duration of current illness, presence of an underlying medical condition and whether the parents had medical insurance. The themes explored included parental perception of illness severity, expectations from the ED visit and the referral pathway.

Results 189 were invited to respond to the survey, full data sets were available on 163. Age range, 5 days-14 years (mean 3.90). The duration of illness was<12 hours 45 (28%), 12–24 hours 12 (7%), 24–48 hours 19 (12%) and>48 hours 87 (53%). Analysis of the referral pathway demonstrated 88 parents (54%) referred by a General Practitioner, 36 (22%) by on-call services, 31 (19%) self-referrals and 8 (5%) Other. Parental expectations at GP practice: No onward referral 73 (59%), referral to ED 50 (40%) and OPD referral 1 (1%). The perception of illness severity from 1–10, showed mean 5.9 (positive skew 37%). As regards admission, 42 parents (26%) thought their child needed admission, 51 (31%) discharge and 70 (43%) undecided. Of 163, 21% were admitted and 79% discharged. The number of children with chronic conditions were 35 (21%).The medical insurance status was private 14 (9%), state provided 69 (42%), u6 visit card 72 (44%) and none 8 (5%). Further breakdown of the u6 card showed, u6 only 37 (51%), u6 and medical card 6 (8%), u6 and private 29 (41%).

Conclusion Our results provide a novel overview of the local referral process to the ED in an Irish General Hospital. They highlight decidedly how the majority of parents presenting to General Practitioners are not anticipating onward referral. This raises an important educational related issue, providing the foundation for further research into methods of enhancing GP training. Furthermore, we obtained unique insight into the effect the introduction of free primary care for children<6 years has had. With increasing workloads for GP’s, it is important to audit practices following these changes to ensure paediatric healthcare providers are adequately resourced.

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