@article{ref1,
title="The impact of out-of-hospital models of care on paediatric emergency department presentations",
journal="Archives of disease in childhood",
year="2018",
author="Viner, Russell M. and Blackburn, Frances and White, Francesca and Mannie, Randy and Parr, Tracy and Nelson, Sara and Lemer, Claire and Riddell, Anna and Watson, Mando and Cleugh, Francesca and Heys, Michelle and Hargreaves, Dougal S.",
volume="103",
number="2",
pages="128-136",
abstract="OBJECTIVE: To estimate the potential impact of enhanced primary care and new out-of-hospital models (OOHMs) on emergency department (ED) presentations by children and young people (CYP). <br><br>DESIGN: Observational study. PATIENTS & SETTING: Data collected prospectively on 3020 CYP 0â€&quot;17.9 years from 6 London EDs during 14 days by 25 supernumerary clinicians. CYP with transient acute illness, exacerbation of long-term condition (LTC), complex LTC/disability and injury/trauma were considered manageable within OOHM. OOHMs assessed included nurse-led services, multispecialty community provider (MCP), primary and acute care system (PACS) plus current and enhanced primary care. MEASURES: Diagnosis, severity; record of investigations, management and outcome that occurred; objective assessment of clinical need and potential alternative management options/destinations. <br><br>RESULTS: Of the patients 95.6% had diagnoses appropriate for OOHM. Most presentations required assessment by a clinician with skills in assessing illness (39.6%) or injuries (30.9%). One thousand two hundred and ninety-one (42.75%) required no investigations and 1007 (33.3%) were provided only with reassurance. Of the presentations 42.2% were judged to have been totally avoidable if the family had had better health education.Of the patients 26.1% were judged appropriate for current primary care (community pharmacy or general practice) with 31.5% appropriate for the combination of enhanced general practice and community pharmacy. Proportions suitable for new models were 14.1% for the nurse-led acute illness team, MCP 25.7%, GP federation CYP service 44.6%, comprehensive walk-in centre for CYP 64.3% and 75.5% for a PACS. <br><br>CONCLUSIONS: High proportions of ED presentations by CYP could potentially be managed in new OOHMs or by enhancement of existing primary care.<br><br>© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.<p /> <p>Language: en</p>",
language="en",
issn="0003-9888",
doi="10.1136/archdischild-2017-313307",
url="http://dx.doi.org/10.1136/archdischild-2017-313307"
}