TY  - JOUR
PY  - 2018//
TI  - The impact of out-of-hospital models of care on paediatric emergency department presentations
JO  - Archives of disease in childhood
A1  - Viner, Russell M.
A1  - Blackburn, Frances
A1  - White, Francesca
A1  - Mannie, Randy
A1  - Parr, Tracy
A1  - Nelson, Sara
A1  - Lemer, Claire
A1  - Riddell, Anna
A1  - Watson, Mando
A1  - Cleugh, Francesca
A1  - Heys, Michelle
A1  - Hargreaves, Dougal S.
SP  - 128
EP  - 136
VL  - 103
IS  - 2
N2  - 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€"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>
LA  - en
SN  - 0003-9888
UR  - http://dx.doi.org/10.1136/archdischild-2017-313307
ID  - ref1
ER  -