A retrospective analysis of frequent attenders to an urban tertiary paediatric emergency department.
INTRODUCTION: Frequent attenders make up a significant number of all attendances to UK Emergency Departments (ED) each year, with many UK trusts developing policies and systems for improving patient outcomes for this cohort, reducing ED workload and making financial savings. There is limited research characterising this group in the UK paediatric population. The Royal College of Emergency Medicine's guideline on managing frequent attenders encourages identification and support of this patient cohort, but makes no specific reference to young people or children. The aim of this project was to gather epidemiological information on the paediatric frequent attenders at an urban tertiary paediatric hospital, in order to identify trends within this group that could be targeted for intervention.
METHODS: We retrospectively analysed data for all patients (<16 years old) who presented on ten or more occasions to the Bristol Royal Hospital for Children ED during the period August 2015 to July 2016. We used scanned electronic records to collect information on clinical presentation and demographic data for each attendance.
RESULTS: In total 47 patients were identified as attending ten or more times within the 12-month study period, accounting for a total of 584 attendances. The median number of patient attendances was 11 (range 10 to 27). Median age at presentation was 26 months. Approximately half of presentations (n=286, 49%) occurred out-of-hours (17:00 to 07:59). Patients were admitted to the observation unit, or to an in-patient bed on 42.8% (n=250) occasions. The ethnic group was recorded as white-British for 79% (n=37). Common reasons for attendance included respiratory difficulty (n=101, 17.3%), fever (n=87, 14.9%), feeding tube problems (n=72, 12.3%), musculoskeletal issues (n=35, 6.0%), seizures (n=27, 4.6%), and overdose (n=22, 3.8%). Of the 47 patients analysed, 36 had complex pre-existing medical conditions including seven oncology patients, eight patients who were born prematurely, and four patients with a confirmed neurological diagnosis.
DISCUSSION: The data gathered from this 12-month period reveals that the majority of paediatric frequent attenders in our sample were younger than 3 years old, with far fewer adolescent patients than initially expected. It is also clear that most of the patients in our cohort had complex medical backgrounds or pre-existing conditions that were responsible for their ED attendances. The high admission rate compared to our overall paediatric ED population represents the higher morbidity carried by this group. While presentation with some medical complaints is unavoidable, we postulate that increased patient and parent education could minimise some reattendances, particularly in those presenting with minor illness. Further allocation of resources towards areas identified as causing reattendance (e.g. feeding tube problems) or support for 'high-risk' patient groups (ex-premature or oncology patients) could also decrease frequency of attendances.
CONCLUSION: We hope that by identifying trends within paediatric frequent attender data we can target interventions to enhance patient and carer experience and avoid ED presentations that could be better managed elsewhere. Further research is required on this subject.
