6639 Minor injury redirection at the front door – a feasibility study at Scotland’s largest tertiary paediatric emergency department

Objectives Children/Young people are amongst the highest users of emergency department (ED) services. A significant proportion of these attendances can be classified as 'non- urgent' or 'low-acuity' and could be managed by other healthcare providers. 1 During peak times they contribute to overcrowding, potentially delaying the timely treatment of patients who require ED level care. 2 In Scotland there is a renewed national focus on directing patients to the 'Right Care in the Right Place'. 3 However, few formalised pathways exist to redirect patients once they have self-presented at an ED 'front door'. This feasibility study was designed to identify and characterise a cohort of patients with minor injuries who could be safely redirected from ED triage to minor injury units (MIU), and to assess the impact introducing such an intervention would have on the volume of ED and MIU attendances in the Greater Glasgow and Clyde (GGC) area. Methods There were 2187 presentations to the Royal Hospital for Children (RHC) Glasgow for the time period 24/07/23 – 06/08/23. A retrospective review of electronic health records was undertaken for 522 triage category 'zero' (minor injury) attendances. A decision tool was developed with nine criteria to identify patients suitable for redirection (see figure 1). Further sub-analysis was performed by time of presentation and post-code to determine potential impact in and out-of-hours (OOH) at five downstream MIUs. Results 29. 7% (155) of all category zero ED attendances met the decision tool criteria and would have been suitable for redirection to a MIU. 60. 5% of all five year and older patients were eligible. Of attendances eligible for redirection, 40% (62) were out-of-hours (19: 00 – 07: 59). 52% (80) of eligible patients would have been directed to one MIU, with the next highest receiving 22% (34) of patients. Conclusion This study suggests a large proportion of patients attending with a minor injury to our ED could be appropriately redirected to MIUs. These results have informed a change of process of paediatric minor injury redirection across GGC, including implementation of this decision tool, and future audits will assess its impact. Decision tools have the potential to significantly reduce the volume of patients in ED and could be expanded to include redirection to self-care for minor illness utilizing the RCPCH endorsed 'Healthier Together' programme. 4 References Simpson RM, O'Keeffe C, Jacques RM, et al. Non-urgent emergency department attendances in children: a retrospective observational analysis, Emergency Medicine Journal 2022;39: 17–22. RCEM Acute Insight Series: Crowding and its Consequences, Boyle A, 2021. Available at: https: //rcem. ac. uk/wpcontent/uploads/2021/11/RCEMWhyEmergencyDepartmentCrowdingMatters. pdf. The new National Redirection Policy, NHSGGC, 2023. Available at: https: //www. nhsggc. scot/your-health/right-care-right-place/redirection/. Healthier Together, NHS Choices, 2023. Available at: https: //www. what0-18. nhs. uk.