Aims To evaluate the impact of a change in triage practice in a district general hospital Emergency department. 16 and 17 year old patients were triaged by paediatric rather than adult nurses, then clerked by the adult team in whichever Emergency area the triage nurse felt was most appropriate for the patient.
Methods Retrospective analysis of visit data from one months’ consecutive Emergency department attendances of 16 and 17 year old patients, totaling 100 patients. Telephone interview of 20 patients, 10 who were seen in the adult area, and 10 who were seen in paediatric area.
Results 67% of presenting complaints were ‘medical’, 13% trauma and 18% related to mental health, drug and alcohol problems. Only 75% of patients transited through the department in four hours or less. 28% of patients were admitted and 4% referred for assessment at a mental health unit. Mental health concerns contributed to 19% of the attendances.
During telephone interview, 100% of patients seen in the paediatric area rated their experience 4 or 5 out of 5 (with 1 being worst and 5 being best), and all preferred to be seen in the children’s area again. 80% of patients seen in the adult area rated their experience 4 or 5 out of 5 and 60% preferred to be seen in the adult area again. Responses regarding staff communication were very positive.
Conclusions The adolescent patients in our study generally had a positive Emergency department experience. Nevertheless their attendances show a high burden of mental health problems and risk taking behaviour, which may have contributed to their lengthy transitions through the department. These adolescents generally do not have any contact with the paediatric system in hospital, despite the fact that they are still legally regarded as children. Emergency department triage by a paediatric nurse may provide a useful bridge for them to transition into adult services with a safety net for mental health and safeguarding concerns to be identified and promptly acted on within the paediatric frameworks.
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