Aim Urgent and emergency care is changing. The White Paper ‘Equity and excellence: Liberating the NHS’ proposed to focus on outcomes. New A&E Clinical Quality Indicators were introduced in 2011 to provide comprehensive assessment of emergency clinical care.
The significance of the unplanned re-attendance rate indicator in paediatrics is uncertain. It is intended to improve care and communication delivered during first presentation.
Our aim is to establish the rate, reasons and significance of re-attendance in our own paediatric A&E.
Methods All children re-attending A&E within 7 days between January - June 2011 were identified by database review. All retrievable records were retrospectively reviewed and the reasons and outcome of unplanned re-attendance recorded.
Results Our hospital is a medium sized UK District General Hospital. 335 episodes of unplanned re-attendance occurred within 6527 paediatric attendances (all children <16 years) giving a rate of 5.1%. 71 record pairs were retrievable and assessed.
Of the 24 (34%) admitted following re-attendance, 79% had a worsening diagnosis requiring new treatment.
Of the 43 (61%) discharged, 88% had an unchanged treatment plan.
Conclusion Our data provides insight why children re-attend our Emergency Department.
We have shown that re-attendance consumes significant resources and must reflect continued parental concern. Underlying cause is likely due both to patient factors and service accessibility and quality.
Our data indicates areas to target improvement: particularly children with chronic health conditions and age under 2 years. Short-stay observation beds or direct ward access may also reduce our rate, though these facilities should be used to provide better service rather than simply to improve quality indicator rates.
Reducing unplanned re-attendance has positive benefits for patients, service capacity and cost efficiency. Across adult specialties optimum rates are considered 1-5% and whilst significance in paediatrics is uncertain, we found a comparable rate in our paediatric A&E. Comparison of rates across a blend of UK Paediatric Units will inform this important discussion.