Emergency Assessment Unit Research Articles

Ascertaining GP demand for a full-time paediatric emergency assessment unit

Changes in the general practitioner (GP) contract have led to the development of a variety of models for managing children who become sick outside of GP surgery hours. One such model is the hospital-based 24-hour paediatric emergency assessment unit (PEAU). This study sought to assess the demand for such a service in one English regional health authority. The opinions of general practitioners (GPs) regarding the service were sought via a fax survey, and a retrospective analysis of out-of-hour admissions staying less than 24 hours, over two discrete three-month periods. Differences in GP referral outcomes were also examined. GPs using the current PEAU (N=431) were invited to participate. GP’s responses, and analysis of PEAU out-of-hours throughput and admission trajectories were obtained. Results indicate that 83.9% of respondent GPs strongly agreed or agreed that the unit should provide a 24-hour PEAU service. 987 sick children were admitted to hospital out of PEAU opening hours, of which 404 had a stay of less than 24 hours. There was widespread approval by GPs to implement a 24-hour PEAU service, however, analysis of the hospital data showed that there were currently insufficient out-of-hours admissions to warrant changes in service delivery.

Poster Prize Winners

1st Prize: What is the effect of a consultant presence in an Acute Medical Unit? 2nd Prize: Weekend mortality for nonelective admissions in England 3rd Prize: VIP – The Red Carpet Treatment? Award for best Non-Medical poster: Do Patients Really Mind Mixed Sex Bays in an Emergency Assessment Unit (EAU)?

Preventing paediatric admissions for respiratory disease: a qualitative analysis of the views of health care professionals

The number of emergency paediatric admissions is increasing each year. The reasons for this are unclear but may include increasing demand from parents, changes in GP working patterns, and an increase in unnecessary admissions. Respiratory disease is the commonest diagnostic category for emergency admission in childhood. To generate hypotheses for reduction in unnecessary admissions for respiratory disease by qualitative analysis of the views of health care professionals, to determine the proportion of preventable admissions as perceived by clinicians, and to assess the modified Paediatric Appropriateness Evaluation Protocol against clinicians judgements of appropriateness of admission. Eight health care professionals analysed clinical data from primary and secondary care for 94 cases that were admitted to an emergency assessment unit and received a hospital discharge diagnosis of respiratory disease. They assessed whether each admission was appropriate, whether it was preventable, and how it might have been prevented. A total of 31% of cases admitted to the assessment unit (29/94) were classified as preventable by the majority of professionals assessing the case. Provision of additional support, monitoring, and observation in the community was cited as a means of prevention in 33/94 cases. There was poor agreement between the modified PAEP and clinicians' assessments of appropriateness of admission (kappa 0.1). If the agreed views of these experienced doctors and nurses are correct, provision of additional services in the community could be an important means of preventing emergency admissions for respiratory disease. This hypothesis should be tested by further research including the views of families. The study provides further evidence that the modified PAEP may not be valid for use in UK practice. If inappropriate admission rates are to be used to measure effectiveness of services we need to develop an objective measure of appropriateness valid for use in the UK.

Award winner.

Unit manager for the emergency assessment unit at Essex Rivers Health- care NHS Trust Rebecca Pulford (pictured) is among the latest nurses selected by The Health Foundation to join its leadership fellows award scheme.

Parental satisfaction with a nurse-led emergency assessment unit

Parents of children dischared from the paediatric emergency assessment unit of a large regional children's unit were surveyed to discover their perceptions of the care experience and post discharge support. Data from 40 parents revealed that the family journey through the unit was generally positive, although not without problems. The majority of children were referred from their general practitioner, and most were seen by a paediatrician within an hour of arrival. Morning-after phone calls and 24-hour access after discharge increased satisfaction. However, nearly a third of families reported they were not shown the facilities of the unit and just under half mentioned lack of privacy as a concern. An action plan to address these issues has been subsequently implemented and will be evaluated periodically.

Parental satisfaction with a nurse-led emergency assessment unit

Parental satisfaction with a nurse-led emergency assessment unit

GP views of nurse-led telephone referral for paediatric assessment

Following the introduction of a new nurse-led telephone referral service to a dedicated paediatric emergency assessment unit (PEAU), a study was conducted to determine the views of general practitioners (GPs) who use the service. The PEAU operates between 10 am and 10 pm on weekdays and between 10 am and 6 pm at weekends. The unit has four beds and treatment and stabilization areas, plus associated services in a dedicated area of a regional child health unit. The design utilized a faxed questionnaire over a 1-month period to all consenting GPs using the PEAU with a postal questionnaire follow-up. Non-parametric Likert scores and qualitative data were used to determine levels of satisfaction with the service and the subsequent management of the referred children. Sixty-nine GPs referred 80 children to the PEAU via the service over a period of 1 month. All consented to participate and were sent a faxed questionnaire, which generated 39 (57%) responses. A follow-up questionnaire sent to the 39 respondents achieved a return of 25 (64%) responses. Thirty-four GPs agreed that referral via the dedicated nurse service was easier than the previous senior house officer referral system. Of the 25 GP respondents to the follow-up postal survey, the majority (17) agreed that the follow-up morning after discharge telephone call to parents by the PEAU nurses was helpful. Four GPs indicated that the 24-hour open access system, offered by the nursing staff, in which a parent may attend PEAU with a discharged child causing concern without a previous appointment, does not always work. This study has shown that a nurse-led telephone referral system to a PEAU for GPs and the subsequent management of the children has been favourably received.

Quadrennial review of a paediatric emergency assessment unit.

The primary aim of this article is to report on one aspect of a quadrennial study designed to explore the appropriateness and impact of the development of a paediatric emergency assessment unit (PEAU) as a response to increases in paediatric emergencies presenting to a south-western regional child health unit. In particular, this article will present the findings of a prospective audit of admissions to the PEAU over a 1-month period during the latter part of 2002. The primary method of data collection utilized a structured survey instrument developed using a design and automatic data computer software package, completed by the nursing staff. Anonymized descriptive data were obtained from 223 children admitted to the PEAU during one calendar moth and authorized by the appropriate clinical directorate audit committee as part of its ongoing commitment to the full implementation of clinical governance. The data presented primarily relate to children admitted during the official opening times of the PEAU, and those presenting out of hours. The data analysis demonstrates a reduction in the number of children staying overnight in hospital since the opening of the PEAU, with the majority of children being referred by their own family doctor. Only one child in the sample was readmitted to the PEAU within 24 hours, and two within 24 hours of discharge as inpatients. Although thought to be pertinent, only one child admitted after official closing of the PEAU and out of hours was described as being admitted for social reasons. The International Classification of Diagnosis (ICD) 10 (World Health Organization (WHO), 1994) classifications of the children admitted to the PEAU reflect those found in other similar studies. Overall, the results of this investigation demonstrate that a PEAU can offer an efficient service to GPs, families and others as a route of referral, thus mitigating unnecessary overnight stays for individual children.

A diversionary tactic? Social work in an emergency assessment unit.

A diversionary tactic? Social work in an emergency assessment unit.

Parental education and guided self-management of asthma and wheezing in the pre-school child: a randomised controlled trial

Background: The effects on morbidity were examined of providing an educational intervention and a written guided self-management plan to the parents of pre-school children following a recent attendance at hospital...