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Management of non-urgent paediatric emergency department attendances by GPs: a retrospective observational study
Simon Leigh1, Bimal Mehta2, Lillian Dummer3
1Institute of Infection and Global Health.
Insights
Integrating a general practitioner (GP) into a pediatric emergency department (ED) significantly reduced wait times and treatment costs for non-urgent cases. This model shows promise for improving pediatric emergency care efficiency.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- General Practice Integration
Background:
- Non-urgent pediatric emergency department (ED) visits are frequent.
- Primary care management is often more appropriate and cost-effective for these cases.
Purpose of the Study:
- To evaluate the impact of integrating a general practitioner (GP) into a pediatric ED.
- Assessed effects on admissions, waiting times, antibiotic prescribing, and costs.
Main Methods:
- Retrospective cohort study in a UK pediatric ED.
- Compared outcomes for non-urgent (Manchester Triage System 'green') cases managed by GP versus ED staff over two years.
- Data analyzed for clinical and operational outcomes, and healthcare costs.
Main Results:
- GP management was associated with significantly shorter ED stays (39 min vs. 165 min).
- Reduced likelihood of inpatient admission (OR 0.16) and long waits >4 hours (OR 0.11).
- Increased antibiotic prescribing (OR 1.42) but 18.4% lower treatment costs.
Conclusions:
- GP integration in pediatric EDs can improve management of non-urgent presentations.
- Models may enhance efficiency and patient experience amidst rising demand.
- Further causative research is needed to confirm these findings.
Background:
Non-urgent emergency department (ED) attendances are common among children. Primary care management may not only be more clinically appropriate, but may also improve patient experience and be more cost-effective.
Aim:
To determine the impact on admissions, waiting times, antibiotic prescribing, and treatment costs of integrating a GP into a paediatric ED.
Design And Setting:
Retrospective cohort study explored non-urgent ED presentations in a paediatric ED in north-west England.
Method:
From 1 October 2015 to 30 September 2017, a GP was situated in the ED from 2.00 pm until 10.00 pm, 7 days a week. All children triaged as 'green' using the Manchester Triage System (non-urgent) were considered to be 'GP appropriate'. In cases of GP non-availability, children considered non-urgent were managed by ED staff. Clinical and operational outcomes, as well as the healthcare costs of children managed by GPs and ED staff across the same timeframe over a 2-year period were compared.
Results:
Of 115 000 children attending the ED over the study period, a complete set of data were available for 13 099 categorised as 'GP appropriate'; of these, 8404 (64.2%) were managed by GPs and 4695 (35.8%) by ED staff. Median duration of ED stay was 39 min (interquartile range [IQR] 16-108 min) in the GP group and 165 min (IQR 104-222 min) in the ED group (P<0.001). Children in the GP group were less likely to be admitted as inpatients (odds ratio [OR] 0.16; 95% confidence interval [CI] = 0.13 to 0.20) and less likely to wait >4 hours before being admitted or discharged (OR 0.11; 95% CI = 0.08 to 0.13), but were more likely to receive antibiotics (OR 1.42; 95% CI = 1.27 to 1.58). Treatment costs were 18.4% lower in the group managed by the GP (P<0.0001).
Conclusion:
Given the rising demand for children's emergency services, GP in ED care models may improve the management of non-urgent ED presentations. However, further research that incorporates causative study designs is required.
