Management of non-urgent paediatric emergency department attendances; a retrospective observational study

BACKGROUND: Non-urgent emergency department(ED) attendances are common among children. Primary care management may not only be more clinically appropriate, but also improve patient experience and cost-effectiveness. AIM: To determine the impact of integrating a general practitioner(GP) into a paediatric ED, on admissions, waiting times, antibiotic prescribing, and treatment costs. DESIGN AND SETTING: Retrospective cohort study of non-urgent ED-presentations in an English paediatric ED. METHOD: From October-2015-September-2017, a GP was situated within the ED, from 2pm-10pm, seven-days-a-week. All children triaged green using the Manchester Triage System(non-urgent) were considered ‘GP-appropriate’. In cases of GP non-availability, non-urgent children were managed by ED-staff. We compared clinical, operational outcomes, and healthcare costs, of children managed by GPs and ED-staff over the same timeframe(2pm-10pm), over a two-year period. RESULTS: Of 115,000 children attending the ED over the study period, 13,099 children were designated ‘GP appropriate’, 8,404(64.2%) managed by GPs and 4,695(35.8%) by ED-staff. Median duration of ED-stay was 39min(IQR 16-108) in the GP-group and 165min(IQR 104-222) in the ED-group(p<0.001). The GP-group were less likely to: be admitted as inpatients (OR 0.16,95%CI 0.13-0.2) and wait longer than four-hours (OR 0.1,95%CI 0.08-0.13), but more likely to receive antibiotics (OR 1.42,95%CI 1.27-1.58). Treatment costs were 18.4% lower in the GP-group,p<0.0001. CONCLUSION: Based on retrospective observational data, children seen by the GP waited less time, had fewer inpatient admissions and lower costs, but experienced higher antibiotic prescribing. Given rising demand for children’s emergency services, ‘GP in ED’ care models may improve the management of non-urgent ED presentations, however further research incorporating causative study designs is required