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Paediatric consultation patterns in general practice and the accident and emergency department
T Bradley1, B McCann, J F Glasgow
1Stewartstown Road Health Centre, Belfast.
Insights
Most children consult general practitioners, with injured children more likely to visit the pediatric accident and emergency department. Further research is needed to assess reducing direct parental referrals for pediatric injuries.
Area of Science:
- Pediatric Emergency Medicine
- Primary Care Pediatrics
- Health Services Research
Background:
- General practitioners (GPs) manage the majority of pediatric healthcare needs.
- Understanding referral patterns between primary and secondary pediatric care is crucial for optimizing resource allocation.
Purpose of the Study:
- To compare the characteristics of children referred to a pediatric accident and emergency (A&E) department versus those consulting their GP.
- To analyze referral triggers, particularly injury, between primary and secondary pediatric care settings.
Main Methods:
- Prospective, simultaneous review of new pediatric consultations over six weeks.
- Data collected from an inner-city teaching hospital's A&E department and a general practice in a deprived urban area.
- Comparison of age, sex, referral source, and diagnosis for 730 children under 13.
Main Results:
- 86% of children initially presented to their GP; only 4% required onward referral to A&E.
- 77% of injured children presented directly to the A&E department, compared to 4% of non-injured children (p < 0.001).
- GPs managed most pediatric consultations effectively, with few injured children needing A&E referral.
Conclusions:
- General practitioners effectively manage the majority of pediatric workload.
- Injured children are significantly more likely to be taken directly to the pediatric A&E department.
- Further investigation into pediatric injury severity is warranted to explore potential reductions in direct A&E referrals.
Abstract:
The age, sex, source of referral and diagnosis of children brought to a paediatric accident and emergency department by their parents were compared to those consulting their general practitioner. A simultaneous, prospective review of these consultations was carried out over a six-week period in an inner-city paediatric teaching hospital and a group practice in a socially deprived urban area. 730 children less than 13 years of age who presented for a new consultation were seen. 629 (86%) presented initially to the general practitioner, who dealt with all but 25 (4.0%) without onward referral to the accident and emergency department. 127 consultations took place at the accident and emergency department, of which 104 (82%) were parental referrals. There was no sex difference in children seen by the general practitioner. There was a decreasing trend with increasing age in the proportion of children who consulted the general practitioner, perhaps due to the higher frequency of injury in the older children. Over three quarters (77%) of injured children were brought directly to the accident and emergency department, compared with only 4% of children without injuries (p < 0.001). Of 22 children with injuries who presented to the general practitioner, only 4 (18%) required onward referral. General practitioners met the great majority of the paediatric workload generated by the practice. Audit between primary and secondary care gives a more reliable picture than data from only one source. Injured children are more likely to be taken to the accident and emergency department. Further study of the severity of injury in children is required to determine if there is potential to reduce parental referrals to accident and emergency departments.