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Clinical quality indicators in the children's emergency department – why do children re-attend?
  1. K Hacking,
  2. W Christian
  1. Children's Emergency Department, Bristol Royal Hospital for Children, Bristol, UK


Background In 2011 the Department of Health replaced the 4 hour target with 8 Clinical Quality Indicators for Emergency Departments (EDs), to monitor and enhance quality of care. One indicator sets a benchmark between 1 and 5 % for improving avoidable unplanned re-attendances within 7 days.

Much of the evidence is from studies in adult EDs, which suggest that factors such as clinician error, chronic conditions and patient information may affect re-attendance.

There is little comparable data in the paediatric setting, where parental expectation and different disease profiles may alter re-attendance rates.


  • To measure the unplanned re-attendance rate in a Paediatric ED

  • To examine why children re-attend and consider:

    • Causes of avoidable re-attendances and ways of reducing these to a safe minimum;

    • Causes of unavoidable re-attendances.

Abstract G296 Table 1

Methods Retrospective review of re-attendances in September 2011. Patient demographics were collected and analysed together with clinical information.

Re-attendances were categorised to determine if patients were representing with:

Results There were 130 unplanned re-attendances in September giving a rate of 5.3%, including 12 patients who represented more than once. The breakdown is as follows:

Median age was 4 years and median time to re-attendance was 48 hours.

Soft tissue injuries, upper respiratory infections and viral illnesses were the commonest reasons for re-attendance. In those requiring admission on re-attendance cellulitis, croup and gastroenteritis were the most common diagnoses.

Conclusions Our re-attendance rate was 5.3%. Some were unavoidable, caused by conditions that may worsen as a natural course of the illness. Safety-netting ensured timely re-attendance in the majority of these cases. Most children however re-attended with the same condition and severity. This group could be minimised with targeted advice, e.g. giving realistic recovery times for soft tissue injuries, promoting the suitability of primary care for follow-up and improved patient information such as online advice. Our hope is that together with data from other centres, our findings will help inform a realistic, national benchmark for paediatric re-attendances.

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