RT Journal Article
SR Electronic
T1 Management of non-urgent paediatric emergency department attendances by GPs: a retrospective observational study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e22
OP e30
DO 10.3399/bjgp20X713885
VO 71
IS 702
A1 Leigh, Simon
A1 Mehta, Bimal
A1 Dummer, Lillian
A1 Aird, Harriet
A1 McSorley, Sinead
A1 Oseyenum, Venessa
A1 Cumbers, Anna
A1 Ryan, Mary
A1 Edwardson, Karl
A1 Johnston, Phil
A1 Robinson, Jude
A1 Coenen, Frans
A1 Taylor-Robinson, David
A1 Niessen, Louis W
A1 Carrol, Enitan D
YR 2021
UL http://bjgp.org/content/71/702/e22.abstract
AB Background Non-urgent emergency department (ED) attendances are common among children. Primary care management may not only be more clinically appropriate, but may also improve patient experience and be more cost-effective.Aim To determine the impact on admissions, waiting times, antibiotic prescribing, and treatment costs of integrating a GP into a paediatric ED.Design and setting Retrospective cohort study explored non-urgent ED presentations in a paediatric ED in north-west England.Method From 1 October 2015 to 30 September 2017, a GP was situated in the ED from 2.00 pm until 10.00 pm, 7 days a week. All children triaged as ‘green’ using the Manchester Triage System (non-urgent) were considered to be ‘GP appropriate’. In cases of GP non-availability, children considered non-urgent were managed by ED staff. Clinical and operational outcomes, as well as the healthcare costs of children managed by GPs and ED staff across the same timeframe over a 2-year period were compared.Results Of 115 000 children attending the ED over the study period, a complete set of data were available for 13 099 categorised as ‘GP appropriate’; of these, 8404 (64.2%) were managed by GPs and 4695 (35.8%) by ED staff. Median duration of ED stay was 39 min (interquartile range [IQR] 16–108 min) in the GP group and 165 min (IQR 104–222 min) in the ED group (P<0.001). Children in the GP group were less likely to be admitted as inpatients (odds ratio [OR] 0.16; 95% confidence interval [CI] = 0.13 to 0.20) and less likely to wait >4 hours before being admitted or discharged (OR 0.11; 95% CI = 0.08 to 0.13), but were more likely to receive antibiotics (OR 1.42; 95% CI = 1.27 to 1.58). Treatment costs were 18.4% lower in the group managed by the GP (P<0.0001).Conclusion Given the rising demand for children’s emergency services, GP in ED care models may improve the management of non-urgent ED presentations. However, further research that incorporates causative study designs is required.