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G217(P) Right place, right time, right care? A study of paediatric emergency care usage
  1. A Mullan1,
  2. E Sefi2,
  3. G Hann3,
  4. S Laurent2
  1. 1Paediatrics and Child Health, University College London, London, UK
  2. 2Paediatrics, Barnet Hospital, Royal Free London NHS Foundation Trust, London, UK
  3. 3Paediatrics, North Middlesex University Hospital, London, UK


Background The emergency attendance rate of children has increased by 28% between 1999 and 2010. An increased proportion of attendances that can be defined as ‘non-urgent’ have been identified to be an important contributing factor. Of total paediatric accident and emergency (A&E) attendances, 58–82% can be defined as ‘non-urgent’. Reasons for A&E attendance include difficulty accessing primary care and the preconception that A&E provides the highest level of treatment.

Aim To determine the reasons parents bring their children to A&E and identify way to improve awareness of alternative services to ensure children are receiving the right care, in the right place, at the right time.

Study Design Prospective questionnaire-based survey of adults accompanying a child to a district general paediatric A&E within the defined survey period.

Results 233 of 300 parents or legal guardians approached, agreed to participate in the study. 94 cases attended during GP hours and 192 attended out of hours. 60% of participants scored a green PEWS and the final outcome for 86% of participants was home. 85 (37%) had accessed other healthcare before coming to the emergency department. Those participants that had already sought healthcare were more likely to do so at their GP (p ≤ 0.02) be aged 0–4 years (p ≤ 0.11) and to present with a respiratory or gastrointestinal problem (p ≤ 0.01). There was an increase in the proportion of participants that had previously accessed other healthcare in the orange and red PEWS groups (p ≤ 0.25). Those with no previous access to healthcare presented more frequently with injury, 43.2% vs 15.5% (p ≤ 0.01). The most common reason for A&E attendance was ‘I felt it was the most appropriate place’, followed by 'wanted to see a paediatrician' and 'no GP appointment available'. Awareness of alternative services was low, ranging from 20% to 39%.

Conclusion Parents perceive A&E to be the most appropriate place for their child to receive treatment. To allow families to make fully informed decisions about where to seek urgent care locally a greater understanding of alternative services’ role in urgent care provision is necessary. Following on from this study we aim to achieve this through introduction of new advertising, coproduced by health professionals and parents.

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