G100(P) “prescribing the remedy: co-located out-of-hours gp – what would thisactuallymean for a paediatric emergency department?”

Abstract

Aims Currently the challenges faced by urgent and emergency services overwhelm the capacity of the system. The publicly perceived lack of accessible and effective alternatives to the emergency department is evident. Co-location of an out of hours GP (OOH-GP) facility enables patients to be appropriately streamed to primary care services following a triage assessment. The College of Emergency Medicine sentinel sites project identified that 15% of ED attendances are ‘inappropriate’, with young children the largest sub-group. We aimed to explore this further. We examined the demographics of patients presenting to a tertiary Paediatric Emergency Department (PED) and assessed the ability of the PED triage nurse in identifying appropriate patients for re-direction to OOH-GP services. The study aimed to assess the potential impact a GP re-direct policy (RP) would have on the PED and patient safety. Methods Patient records were reviewed for all triage category 4 and 5 (T4 and T5) patients presenting to the PED in June (1st–14th) and September (8th–21st). Demographic data was obtained and reviewed. Cases were assessed for eligibility against a current OOH-GP RP being utilised in a local mixed ED. Additionally, during the second 2-week period in September the ED triage nurse (TN) provided their subjective opinion, based solely on their triage assessment, on whether the patient was appropriate for GP redirect. Results 1,556 T4 and T5 cases present to the PED – over 30% fulfilled the OOH-GP RP criteria. This increased to 50% in under 1s. 70% of all T4 and T5 cases were self-referrals with 34% eligible for OOH-GP redirect. GP/OOH-GP referrals made up 17% cases but 30% of these also fulfilled the RP to OOH-GP services. Using the RP, 3.8% of all patients would be ‘inappropriately’ redirected but if decision to re-direct were based only on TN assessment this reduced to 3.6% with a 58% reduction in T4 and 5 patients being seen ‘unnecessarily’ in the PED. Conclusions Over 30% of T4 and 5 patients presenting to the ED would be appropriate for re-direction to primary care services – 12% of all attendances. This would be considerably higher if a more inclusive RP was created to account for trivial and non-urgent presentations to ED. TN assessment safely and accurately identifies patients requiring PED specific care.