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[Pediatric emergencies attended at a primary care clinic (I): Analysis of demand]
G Fernández Cano1, G Martín Carballo
1Pediatras de Equipo de Atención Primaria, Madrid.
Insights
Paediatric emergencies constitute a significant portion of primary care visits, often disrupting clinic schedules. Many cases could have been managed with a prior appointment, highlighting organizational challenges.
Area of Science:
- Primary Care Pediatrics
- Emergency Medicine
- Healthcare Management
Background:
- Paediatric emergencies present unique challenges in primary care settings.
- Understanding the patterns and reasons for emergency visits is crucial for optimizing healthcare delivery.
Purpose of the Study:
- To investigate the characteristics and underlying factors of paediatric emergencies in a primary care clinic.
- To evaluate the suitability of the primary care setting for managing these emergencies.
Main Methods:
- A prospective, longitudinal study was conducted over one year in an urban paediatric clinic.
- Data collected on non-scheduled consultations for children aged 0-14 registered with the clinic.
Main Results:
- Paediatric emergencies accounted for 21.1% of non-scheduled consultations, averaging 5.8 per day.
- Peak times included Mondays, October, and Autumn afternoons; 41.8% of cases could have been scheduled appointments.
- Convenience (16.7%) and symptoms appearing after clinic hours (43.2%) were key reasons for emergency visits, with younger children (under 6) attending most frequently.
Conclusions:
- Paediatric emergencies significantly impact primary care clinic organization.
- A substantial proportion of emergency visits are potentially avoidable through better appointment scheduling and patient education.
- Convenience and after-hours symptom onset are major drivers of paediatric emergency room use in primary care.
Objectives:
To study paediatric emergencies in a primary care clinic, evaluating how suitable it is and the factors underlying the emergencies.
Design:
A prospective, longitudinal study during the working days of alternate weeks between July 1 1996 and June 30 1997.
Setting:
Urban paediatrics clinic, on the afternoon shift (2 to 9 p.m.), of the Vicente Soldevilla Primary Care Team (PCT) in Vallecas (Madrid).
Participants:
Population registered with the PCT: 2890 children between 0 and 14.
Results:
723 emergencies were attended (consultations without prior appointment), which represented 21.1% of all non-scheduled consultations. The mean was 5.8 +/- 2.8 emergencies per day (range 0-13). They were more common on Mondays (6.8 +/- 2.4), in October (8.2 +/- 1.6) and in Autumn (5.8 +/- 2.6). 95% were of children registered with the PCT. Maximum attendance was between 4 p.m. and 7 p.m. (59%), coinciding with the on-demand clinic. 6.9% of the emergencies were unjustified, 51.3% were justified, and 41.8% could have asked for an appointment beforehand. The main reasons for attending as an emergency were: the symptoms beginning after the appointments desk had closed (43.2%), convenience (16.7%) and importance of the illness (12.4%).
Conclusions:
Emergencies make up a large proportion of consultations, and distort the organisation of the day's activities. 41.8% of cases could have requested a prior appointment. It is striking that 16.7% said they attended as an emergency for convenience. Children under 6 were those who attended emergencies most.