Article Text
Abstract
Objective To evaluate the impact of integrating a general practitioner (GP) into a tertiary paediatric emergency department (ED) on admissions, waiting times and antibiotic prescriptions.
Design Retrospective cohort study.
Setting Alder Hey Children’s NHS Foundation Trust, a tertiary paediatric hospital in Liverpool, UK.
Participants From October 2014, a GP was colocated within the ED, from 14:00 to 22:00 hours, 7 days a week. Children triaged green on the Manchester Triage System without any comorbidities were classed as ‘GP appropriate’. The natural experiment compared patients triaged as ‘GP appropriate’ and able to be seen by a GP between 14:00 and 22:00 hours (GP group) to patients triaged as ‘GP appropriate’ seen outside of the hours when a GP was available (ED group). Intention-to-treat (ITT) analysis was used to assess the main outcomes.
Results 5223 patients were designated as ‘GP appropriate’—18.2% of the total attendances to the ED over the study period. There were 2821 (54%) in the GP group and 2402 (46%) in the ED group. The median duration of stay in the ED was 94 min (IQR 63–141) for the GP group compared with 113 min (IQR 70–167) for the ED group (p<0.0005). Using the ITT analysis equivalent, we demonstrated that the GP group were less likely to: be admitted to hospital (2.2% vs 6.5%, OR 0.32, 95% CI 0.24 to 0.44), wait longer than 4 hours (2.3% vs 5.1%, OR 0.45, 95% CI 0.33 to 0.61) or leave before being seen (3.1% vs 5.7%, OR 0.53, 95% CI 0.41 to 0.70), but more likely to receive antibiotics (26.1% vs 20.5%, OR 1.37, 95% CI 1.10 to 1.56). Sensitivity analyses yielded similar results.
Conclusions Introducing a GP to a paediatric ED service can significantly reduce waiting times and admissions, but may lead to more antibiotic prescribing. This study demonstrates a novel, potentially more efficient ED care pathway in the current context of rising demand for children’s emergency services.
- primary care
- emergency department
- quality improvement methodologies
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Footnotes
DT-R and D contributed equally.
LS and YN contributed equally.
Contributors EDC, DTR-R and MR designed the study. LS, YN and KE collected the data. AIP and SL performed statistical analysis. KJ and SB contributed to data collection. LS and YN wrote the first draft of the paper. SL, AIP, DT-R and EDC wrote subsequent drafts. All authors contributed to the final draft of the paper, and read and approved the final draft of the paper.
Funding Professor David Taylor-Robinson is funded by the MRC on a Clinician Scientist Fellowship (MR/P008577/1).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data were obtained from an NHS hospital. There are no additional unpublished data available.
Presented at Presented in part Royal College of Paediatrics and Child Health annual meeting 2016. Abstract G211