PMID- 33257462
OWN - NLM
STAT- MEDLINE
DCOM- 20210624
LR  - 20210624
IS  - 1478-5242 (Electronic)
IS  - 0960-1643 (Print)
IS  - 0960-1643 (Linking)
VI  - 71
IP  - 702
DP  - 2021 Jan
TI  - Management of non-urgent paediatric emergency department attendances by GPs: a 
      retrospective observational study.
PG  - e22-e30
LID - 10.3399/bjgp20X713885 [doi]
AB  - 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.
CI  - (c)The Authors.
FAU - Leigh, Simon
AU  - Leigh S
AD  - Institute of Infection and Global Health.
FAU - Mehta, Bimal
AU  - Mehta B
AD  - Emergency Department.
FAU - Dummer, Lillian
AU  - Dummer L
AD  - School of Medicine, University of Liverpool, Liverpool.
FAU - Aird, Harriet
AU  - Aird H
AD  - School of Medicine, University of Liverpool, Liverpool.
FAU - McSorley, Sinead
AU  - McSorley S
AD  - School of Medicine, University of Liverpool, Liverpool.
FAU - Oseyenum, Venessa
AU  - Oseyenum V
AD  - School of Medicine, University of Liverpool, Liverpool.
FAU - Cumbers, Anna
AU  - Cumbers A
AD  - Primary Care 24, Liverpool.
FAU - Ryan, Mary
AU  - Ryan M
AD  - Primary Care 24, Liverpool.
FAU - Edwardson, Karl
AU  - Edwardson K
AD  - Information Department, Alder Hey Children's NHS Foundation Trust, Liverpool.
FAU - Johnston, Phil
AU  - Johnston P
AD  - Information Department, Alder Hey Children's NHS Foundation Trust, Liverpool.
FAU - Robinson, Jude
AU  - Robinson J
AD  - School of Social and Political Sciences, University of Glasgow, Glasgow.
FAU - Coenen, Frans
AU  - Coenen F
AD  - Department of Computer Science.
FAU - Taylor-Robinson, David
AU  - Taylor-Robinson D
AD  - Department of Public Health and Policy.
FAU - Niessen, Louis W
AU  - Niessen LW
AD  - Liverpool School of Tropical Medicine, Liverpool.
FAU - Carrol, Enitan D
AU  - Carrol ED
AD  - Institute of Infection and Global Health.
LA  - eng
GR  - G0802448/MRC_/Medical Research Council/United Kingdom
GR  - MR/P008577/1/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20201228
PL  - England
TA  - Br J Gen Pract
JT  - The British journal of general practice : the journal of the Royal College of 
      General Practitioners
JID - 9005323
SB  - IM
MH  - Child
MH  - *Emergency Service, Hospital
MH  - England
MH  - Hospitalization
MH  - Humans
MH  - Retrospective Studies
MH  - *Triage
PMC - PMC7716877
OTO - NOTNLM
OT  - antibiotics
OT  - cost-effectiveness
OT  - emergency care
OT  - paediatrics
OT  - primary care
EDAT- 2020/12/02 06:00
MHDA- 2021/06/25 06:00
PMCR- 2020/12/01
CRDT- 2020/12/01 05:54
PHST- 2020/03/10 00:00 [received]
PHST- 2020/05/20 00:00 [accepted]
PHST- 2020/12/02 06:00 [pubmed]
PHST- 2021/06/25 06:00 [medline]
PHST- 2020/12/01 05:54 [entrez]
PHST- 2020/12/01 00:00 [pmc-release]
AID - bjgp20X713885 [pii]
AID - 10.3399/bjgp20X713885 [doi]
PST - epublish
SO  - Br J Gen Pract. 2020 Dec 28;71(702):e22-e30. doi: 10.3399/bjgp20X713885. Print 
      2021 Jan.