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The impact of out-of-hospital models of care on paediatric emergency department presentations
  1. Russell M Viner1,2,
  2. Frances Blackburn1,
  3. Francesca White1,
  4. Randy Mannie3,
  5. Tracy Parr1,
  6. Sara Nelson1,
  7. Claire Lemer4,
  8. Anna Riddell5,
  9. Mando Watson6,
  10. Francesca Cleugh6,
  11. Michelle Heys2,
  12. Dougal S Hargreaves1
  1. 1 Healthy London Partnerships, London, UK
  2. 2 UCL Great Ormond Street Institute of Child Health, London, UK
  3. 3 Financial Strategy, NHS England (London Region), London, UK
  4. 4 Evelina London Children’s Hospital, Guy’s and St Thomas' NHS Foundation Trust, London, UK
  5. 5 Barts Health NHS Trust, London, UK
  6. 6 Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Professor Russell M Viner, UCL Great Ormond St., Institute of Child Health, 30 Guilford St., London WC1N 1EH, UK; r.viner{at}


Objective To estimate the potential impact of enhanced primary care and new out-of-hospital models (OOHMs) on emergency department (ED) presentations by children and young people (CYP).

Design Observational study.

Patients & setting Data collected prospectively on 3020 CYP 0–17.9 years from 6 London EDs during 14 days by 25 supernumerary clinicians. CYP with transient acute illness, exacerbation of long-term condition (LTC), complex LTC/disability and injury/trauma were considered manageable within OOHM. OOHMs assessed included nurse-led services, multispecialty community provider (MCP), primary and acute care system (PACS) plus current and enhanced primary care.

Measures Diagnosis, severity; record of investigations, management and outcome that occurred; objective assessment of clinical need and potential alternative management options/destinations.

Results Of the patients 95.6% had diagnoses appropriate for OOHM. Most presentations required assessment by a clinician with skills in assessing illness (39.6%) or injuries (30.9%). One thousand two hundred and ninety-one (42.75%) required no investigations and 1007 (33.3%) were provided only with reassurance. Of the presentations 42.2% were judged to have been totally avoidable if the family had had better health education.

Of the patients 26.1% were judged appropriate for current primary care (community pharmacy or general practice) with 31.5% appropriate for the combination of enhanced general practice and community pharmacy. Proportions suitable for new models were 14.1% for the nurse-led acute illness team, MCP 25.7%, GP federation CYP service 44.6%, comprehensive walk-in centre for CYP 64.3% and 75.5% for a PACS.

Conclusions High proportions of ED presentations by CYP could potentially be managed in new OOHMs or by enhancement of existing primary care.

  • integrated care
  • health services research
  • epidemiology
  • health service

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  • Contributors The study was conceived and designed by RMV, TP, FB and RM. CL, AR, MW, FC and DSH helped to refine the design. FB, FW, SN and TP organised and undertook data collection. RMV led the analyses, with input from FB and FW. RMV led the writing of the paper, with input from DSH, FW, TP and MH. All authors approved the final version of the paper.

  • Funding Funding for this study was provided by the Children and Young People’s Board of Healthy London Partnerships, a transformation programme jointly funded and administered by NHS England (London Region) and the London Board of CCGs.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon request to the first author, RMV.

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