6848 Are the holes in the ‘preventive care sieve’ getting too big? – trends in acuity of ED attendances of infants

Objectives Emergency department (ED) attendances among infants have increased in high resources settings over the past ten years¹; a trend continuing post-Covid.² Low acuity attendances have also increased, in part due to gaps in preventative care services.³ National data shows significant regional variation in paediatric ED attendance rates, and social determinants of health also vary with location.⁴ Local data and insights are required to inform policy and interventions to reduce ED attendances. We aim to describe infant ED attendances in the past 6 years, including acuity level and numbers admitted, at a busy London district general hospital. Methods Data for all children aged 0–12 months attending the emergency department were extracted from the internal operational electronic information systems (SMISS and Symphony) from 01/01/2018 to 15/05/2023. Details included demographics, assigned acuity level at triage, initial complaint, diagnosis, admission rates and GP practice. Analysis was undertaken using excel including descriptive statistics and Chi squared test for trend. Ethics approval was not required in line with HRA guidance. Results 21,319 infants aged 0–12 months attended ED during the study period. Attendance numbers were reasonably stable over time with a decrease in 2020 over the Covid-19 pandemic (see table 1). Younger infants were more likely to be admitted (p<0.0001). The proportion of children admitted per year substantially decreased over the 6-year period (p<0.0001). See table 1. The most commonly assigned acuity level was 4 (lower acuity) and a higher acuity level was associated with increased chance of admission (p<0.0001). However, among infants assigned acuity level 1 (highest acuity), 52.7% were still discharged home from ED. See figure 1. Conclusion While ED attendances among infants remain high, the proportion resulting in admission has decreased over the last 6 years. The majority of ED attendances are of lower acuity, and even those assigned higher acuity are frequently discharged from ED. Lower acuity attendances add to department overcrowding and healthcare costs which could be avoided by management by community services or primary care. Assigned acuity levels are correlated with the probability of admission, but are not good predictors of outcome. There is a lack of consensus on triage categories, acuity classification and what constitutes a low acuity attendance. A standardised definition used consistently would enable national comparison of data between services. References Royal College of Paediatrics and Child Health, Facing the future: standards for children in emergency care settings, 2018. Ward J, Hargreaves D, Rogers M, Firth A, Turner S, Viner R, Recent and forecast post-COVID trends in hospital activity in England amongst 0 to 24 year olds: analyses using routine hospital administrative data, MedRxiv, 2021:2021.02. 11.21251584. Alele FO, Emeto TI, Callander EJ, Watt K, Non-urgent paediatric emergency department presentation: A systematic review, Journal of Paediatrics and Child Health, 2019;55(3):271–7. Nath S, Zylbersztejn A, Viner RM, Cortina-Borja M, Lewis KM, Wijlaars L, et al. Determinants of accident and emergency attendances and emergency admissions in infants: birth cohort study, BMC Health Serv Res. 2022;22(1):936.