6865 Low acuity presentations to the paediatric emergency department: the district general hospital perspective

Objectives Attendances to the emergency department (ED) are increasing at a striking rate. Low-acuity (LA) presentations to the ED contribute to a significant volume of these patients, with studies estimating between 36 and 60%. 1 The paediatric emergency department (PED) is no different. LA presentations not only further restrict finite healthcare resources but also contribute negatively to staff wellbeing, flow, and operating capacity in ED. 2 A lack of consensus exists on the definition of LA presentations, with no overall agreement on these patients who can safely be seen in a healthcare setting other than the ED. Defining and characterising the problem of LA presentations is half the solution. To address LA presentations, we need to better understand LA patients, their reasons for presentation, and subsequent care outcomes. In this service evaluation project, we sought to characterise LA patients presenting to a district general hospital (DGH) PED. Methods In this project, LA presentations were defined as patients presenting with a Manchester Triage Score (MTS) score equal to or greater than 3. All LA patients aged 0–17 years presenting between June 1st, 2022, and May 31st, 2023, were included. Retrospective anonymised data was collected using electronic health records (EHRs). From these patients, the following data was collected: demographics, chief complaints, treatment, and eventual discharge destination. Patients admitted, died, or transferred to another hospital were excluded. Results 17, 214 individuals met our selection criteria (out of 21, 364 patients). Median age was 6 years (IQR 1–11). Children under 5 years of age constituted 53% of patients, while adolescents comprised of 20%. Most patients, 72%, had an MTS of 4, with 25% having an MTS of 3. 60% had a PEWS of 0 on triage. Only 1. 4% of patients had a PEWS equal to or greater than 2. No variations were observed with respect to the number of attendances on different days of the week or months of the year. The three most frequently reported chief complaints were fever, cough, and abdominal pain. On discharge from PED, the most common diagnoses were upper respiratory tract infection, 'no abnormality detected', and tonsillitis. 6% of patients underwent blood tests. Specialty referral mainly involved the paediatric team, encompassing 11% of patients, followed by orthopaedic referrals, which accounted for 1% of referrals. Lastly, 1% of patients received a prescription for salbutamol, while 13% were prescribed oral antibiotics upon discharge. Conclusion LA presentations to the PED impose a substantial strain on the delivery of care. In our project, LA presentations contributed to 80% of total presentations for our PED. The overwhelming majority of LA patients were discharged home without any medications. To alleviate service strain, further research is necessary, both locally and nationally, to develop optimal patient- and department-centric pathways that ensure patients are seen safely in settings other than ED. References Poku BA, Hemingway P. Reducing repeat paediatric emergency department attendance for non-urgent care: a systematic review of the effectiveness of interventions. Emergency Medicine Journal, 2019. p. emermed-2018–207536. Doi: https: //doi. org/10. 1136/emermed-2018-207536. Boyle A. (2021). RCEM Acute Insight Series: Crowding and its Consequences. online Available at: https: //rcem. ac. uk/wp- content/uploads/2021/11/RCEMWhyEmergencyDepartmentCrowdingMatters. pdf.