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Are the urgent care services effective for febrile children under five years? A parental and professional perspective
  1. R Ranmal1,
  2. S Maguire2,
  3. S Komulainen1,
  4. S Pearse1,
  5. T Stephenson1,
  6. on behalf of the Fever Project Board3
  1. 1Science and Research, Royal College of Paediatrics and Child Health, London, UK
  2. 2Child Health, Cardiff University, Cardiff, UK
  3. 3RCPCH, RCGP, CEM, NHS Direct, JRCALC, Universities of Leicester and Nottingham, UK


Aims Children account for 2.9 million emergency department (ED) attendances/year, and a quarter of NHS Direct calls. The authors wished to explore use of urgent care services by parents of children less than five years, from a parental and professional perspective, framed around the National Institute for Health and Clinical Excellence febrile illness guideline.

Methods Parents using any urgent care service (general practitioner (GP)/walk in centre/out of hours GP/children's admissions unit/ED/other primary care services/ambulance/NHS direct) within Leicestershire, Peterborough, North West London for a febrile child <5 years during January 2009 to June 2009 were approached. Data collected via a parent telephone questionnaire, and the clinical notes.

Results Of 556 parents expressing an interest, 220 enrolled, making 570 contacts (median 3, range 1–13) across all services during this illness, despite the child's episode of illness lasting only 3 days on average. Parents understood local urgent care options, and their first preference was to see a G) (67%; 93/138); and when they were unavailable, NHS Direct (46%; 38/82). Although there were 83 attendances at ED at any point, 49% were advised to do so by another service. 155 made more than one contact involving 505 contacts; 48% (242) of which were initiated by a service provider. Less than 17% of children were “high risk” during the illness, with no deaths. Children were appropriately triaged by the services in 60% of cases. Safety netting was given to 80%; those without this were more likely to re-present than those who did (51% vs 30%, p<0.05) Parents identified a need for precise, consistent, written advice regarding fever and antipyretics.

Conclusion The parents were aware of urgent care service options available, and their first choice was the GP. Multiple contacts are being made, for relatively well children, during self-limiting illnesses, often due to repeated referrals within the system, not initiated by parents. When safety net advice is given, it reduces re-attendances, but parents need more explicit and consistent advice for appropriate home management.

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