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G35(P) The impact of an urgent care centre on patient flow with musculoskeletal (MSK) injuries in a paediatric emergency department
  1. D Birahinduka1,
  2. C Stewart2
  1. 1Paediatric Department, Northwick Park Hospital, London, UK
  2. 2Paediatric Emergency Department, Chelsea and Westminster Hospital, London, UK

Abstract

Background In paediatric accident and emergency there is a tendency to prioritise patients with medical problems over musculoskeletal injury.

To more appropriately serve our low acuity MSK population, a GP led urgent care centre (UCC) was set up in 2011.

Our aim was to evaluate whether a dual patient tracking system would improve the management of patients with MSK injuries requiring non urgent imaging.

Methods A retrospective review of 200 attendances over four separate months with MSK injuries was carried out using an electronic patient record (50 patients for January and July) before and after the new UCC tracking system (Adastra). This study compares data on the time from triage to requesting imaging and the total time from triage to discharge.

Results Children waited 28 mins longer for imaging to be requested in January 2102 compared to January 2010: [58.5 mins 95% CI (46.1, 70.8) vs 30.9 mins 95% CI (21.4, 40.4), p-value 0.01]. Results show a similar pattern comparing July to July before and after UCC [33.1 mins 95% CI (20.2, 46.1) vs 62 mins 95% CI (47, 77.1) p <0.01]. The length of time from assessment to discharge was nearly 20 minutes longer in January 2012 compared to January 2010: 69.35 mns 95% CI (50.62, 88.08) vs 50.77 mns 95% CI (38.1, 63.3), p value 0.05.

Conclusion The new UCC patient tracking system is associated with a significant delay in imaging children presenting with low acuity MSK injuries. This leads to overcrowding and inefficiency, and not the improved service for which UCC was originally devised. A review of the entire patient journey may improve the management of children with MSK requiring non immediate imaging.

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