G339(P) An evaluation of primary care streaming in a tertiary paediatric emergency department

Abstract

Background Over the last 5 years, attendances at major emergency departments (ED) have increased by 3000 patients per day. Primary care streaming has the potential to mitigate this increased demand. However, while one UK study in a tertiary paediatric ED found that a co-located General Practitioner (GP) significantly reduced waiting times and admissions, a Cochrane review has concluded there is a lack of evidence to support the effectiveness of primary care services in ED. Aim To evaluate the impact of primary care streaming on the paediatric ED service for patients presenting with non-urgent medical problems. Method This service evaluation was conducted from January – December 2018 in a tertiary paediatric ED. At triage, patients who met specified criteria were assigned to the ‘primary care’ category. The evaluation compared patients seen by a co-located GP during term time, between 1800–2300 on weekdays and 1100–2000 on weekends, with patients seen by ED staff presenting at other times, or when the GP service was full/unstaffed. Data was collected from ED and GP electronic systems and analysed using Excel. The main outcome measures were patient numbers, length of stay (LOS), admission rates, unplanned ED re-attendances, number of investigations and prescriptions. Results Interim results show that, from January – June 2018, 3646 primary care patients attended the ED. 38.2% attended during primary care streaming hours, of which, 30% saw a GP. The difference in median LOS was 45 min (ED 108.25 vs. GP 63.5). The GP investigated 5.4% (ED 7.6% vs GP 7.2%) and prescribed for 1.7% (ED 34.9% vs GP 34.3%) fewer patients than ED staff. Admission rates were similar in both groups (ED 3.15% vs GP 3.5%). There was a 31.7% reduction in the re-attendance rate for patients seen by the GP (ED 9.7% vs GP 7.1%). Conclusion For patients with non-urgent medical problems, primary care streaming significantly reduces length of ED stay without an increased admission rate. Additionally, is a trend towards a reduced re-attendance rate suggesting that the primary care streaming model implemented is safe and effective.