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Unscheduled re-attendances to a paediatric Emergency Department: an audit
  1. Lisa Black

Abstract

Introduction Unscheduled re-attendances (UR) continue to pose a problem to the Paediatric Emergency Department (PED) and there is paucity of research on this topic. 5% of PED attendances are UR.1 Although some are inevitable, it is important to identify strategies to minimise such attendances.

Objectives To estimate the size of the problem, identify high risk patient groups and determine other factors (system or doctor) related to UR within an inner city PED.

Methods All patients under the age of 17, who reattended within 72 h, over a 28-day period, were identified and their Emergency Department notes reviewed.

Results 91 children were identified, which represented an UR rate of 3.88%, of which 69 (76%) were under 5 years old. Gastroenteritis (GE) and upper respiratory tract infection (URTI) were the predominant causes of UR. 67% of children were assessed by a junior doctor (JD {< ST2}) on initial presentation. On re-attendance, 74% were again assessed by a JD contrary to department policy and on both occasions less than half were discussed with a senior doctor. Only 70% were discharged with a documented safety net advising appropriate re-attendance. Four children had a revised diagnosis on re-attendance and 22% were ultimately admitted.

Conclusions UR is an important performance indicator and a periodic review should be a part of clinical governance activity. High risk groups for UR were <5 s, GE and URTI. We suggest that improved discharge information for parents with expected disease course, better supervision of JD / initial senior review and better collaboration with primary care providers may decrease such UR.

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