Children and young people seen in a co-located primary care hub; an observational study
Introduction:
The total number of visits to Emergency Departments (ED) in the National Health Service (NHS) in England exceeded 22 million in 2014–2015, an increase of 35% over the last decade. Over 30% of these visits could potentially be managed in primary care. One proposed solution for this ever-increasing demand has been the creation of co-located primary care services in or alongside the ED. Since October 2017 University Hospital Southampton has worked in conjunction with a local primary care provider to run a co-located primary care hub. Patients presenting to ED are streamed to the hub provided they do not meet any of the set age/clinically defined exclusion criteria.
Our aim was to compare the care received by children and young people less than 18 years old streamed to the primary care hub in comparison with those receiving routine care in the ED in the first three months of its operation.
Methods:
Data was collected for the period 1/10/17 - 31/12/17 (3 months). Retrospective case note analysis was performed using the “System One” IT system for all children and young people seen in the primary care hub during its opening times (Monday-Friday 1800-2200, Saturday-Sunday 1100-2200). This was compared with children and young people seen in the ED outside these times using the “Symphony” IT system. The ED group were searched using the same exclusion criteria used at streaming to exclude redirection to the primary care hub (
Results:
During the study period 336 children and young people were seen in the primary care hub with 1438 matched patients seen in ED. Mean time in the department for patients seen in the primary care hub was lower than in ED (1 hour 19 minutes v 2 hours 45 minutes p<0.01). Investigation rate was lower for those seen in the primary care hub ((5/336 (1.48%) v 77/1338 (5.75%) p0.01). A higher proportion of those seen in the primary care hub received drugs to take home than those seen in ED (( 124/336 (36.80%) v 236/1338 (17.64%) p<0.01). The most frequently prescribed three groups of drugs for both groups were antibiotics, bronchodilators and analgesia.
Discussion
Initial experience of a co-located primary care hub model has demonstrated significant benefits in waiting times as well as demonstrating a lower rate of investigation. We have highlighted a significantly higher prescribing rate, similar to that seen in previous work, though more work is needed to understand the exact prescribing patterns involved. This demonstrates the potential for shared learning across both services. While this work demonstrates the model’s promise, further work is needed to study patient experience before recommending its wider expansion and implementation.
