Paediatric emergency department referrals from primary care
Erin Turbitt A and Gary Lee Freed A BA Health Systems and Workforce Unit, Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Parkville, Vic. 3010, Australia. Email: turbitte@unimelb.edu.au
B Corresponding author. Email: gary.freed@unimelb.edu.au
Australian Health Review 40(6) 691-695 https://doi.org/10.1071/AH15211
Submitted: 5 November 2015 Accepted: 1 February 2016 Published: 9 March 2016
Abstract
Background Over the last decade, paediatric referrals from general practitioners (GPs) to the emergency department (ED) have increased by 60% in Australia.
Objective To investigate the characteristics of Victorian children referred by GPs to the ED with lower-urgency conditions.
Method Data were collected from four hospital EDs in Victoria, May–November 2014. Parents attending the ED with their child triaged as lower urgency were surveyed. Descriptive, frequency, and bivariate analyses were performed.
Results Of the 1150 responses, 28% (320) visited their GP before attending ED. Of these 66% (212), were referred by their GP. A greater proportion with injury than illness (84% vs 59%; P < 0.0001) was referred to the ED if they had first visited their GP.
Conclusion Motivations of GPs to send lower-urgency injured and ill children to ED are not well understood. The high number of referrals from GPs to the ED for lower urgency conditions suggests attention by policy makers and health professionals must be paid to the current patterns of care of children in general practice.
What is known about the topic? Paediatric referrals in Australia from GPs to EDs have increased in the last decade, along with the absolute number of children in Victoria presenting to the ED.
What does this paper add? A significant number of children (66%) who attend the GP before visiting the ED are referred to the ED for their lower urgency condition.
What are the implications for practitioners? It may be appropriate for GPs to be further supported to manage lower urgency conditions, through better resources or education.
Additional keywords: child health services, consultation, emergency medicine, general practice, parents, primary healthcare.
References
[1] Charles J, Valenti L, Britt H. Referrals to A&E: Changes over 5 years. Aust Fam Physician 2012; 41 365| 22848916PubMed |
[2] Britt H, Miller GC, Henderson J, Bayram C, Valenti L, Harrison C, Pan Y, Wong C, Charles J, Chambers T, Gordon J, Pollack AJ. A decade of Australian general practice activity 2004–05 to 2013–14. General practice series no. 37. Sydney: Sydney University Press; 2014.
[3] Charles J, Valenti L, Britt H. Referrals to A&E. Aust Fam Physician 2008; 37 505
| 18592065PubMed |
[4] Freed GL, Gafforini S, Carson N. Age distribution of emergency department presentations in Victoria. Emerg Med Australas 2015; 27 102–7.
| 25690308PubMed |
[5] Field S, Lantz A. Emergency department use by CTAS Levels IV and V patients. Cal J Emerg Med 2006; 8 317–22.
[6] Hendry SJ, Beattie TF, Heaney D. Minor illness and injury: factors influencing attendance at a paediatric accident and emergency department. Arch Dis Child 2005; 90 629–33.
| Minor illness and injury: factors influencing attendance at a paediatric accident and emergency department.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M3msFKjtA%3D%3D&md5=e32ae36294841e3741449bdc1f821b92CAS | 15908631PubMed |
[7] Northington WE, Brice JH, Zou B. Use of an emergency department by nonurgent patients. Am J Emerg Med 2005; 23 131–7.
| Use of an emergency department by nonurgent patients.Crossref | GoogleScholarGoogle Scholar | 15765330PubMed |
[8] Phelps K, Taylor C, Kimmel S, Nagel R, Klein W, Puczynski S. Factors associated with emergency department utilization for nonurgent pediatric problems. Arch Fam Med 2000; 9 1086–92.
| Factors associated with emergency department utilization for nonurgent pediatric problems.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2FoslWjtw%3D%3D&md5=cdc5c77653b3610c764244a33f88c5d1CAS | 11115212PubMed |
[9] Redstone P, Vancura JL, Barry D, Kutner JS. Nonurgent use of the emergency department. J Ambul Care Manage 2008; 31 370–6.
| Nonurgent use of the emergency department.Crossref | GoogleScholarGoogle Scholar | 18806596PubMed |
[10] Shesser R, Kirsch T, Smith J, Hirsch R. An analysis of emergency department use by patients with minor illness. Ann Emerg Med 1991; 20 743–8.
| An analysis of emergency department use by patients with minor illness.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3M3ptVelug%3D%3D&md5=28cca92114f730b801c83f551aa118b4CAS | 2064094PubMed |
[11] Weiss AL, D’Angelo LJ, Rucker AC. Adolescent use of the emergency department instead of the primary care provider: who, why, and how urgent? J Adolesc Health 2014; 54 416–20.
| Adolescent use of the emergency department instead of the primary care provider: who, why, and how urgent?Crossref | GoogleScholarGoogle Scholar | 24210899PubMed |
[12] Nagree Y, Gosbell A, McCarthy S, Moore K, Mountain D. Determining the true burden of general practice patients in the emergency department: getting closer. Emerg Med Australas 2013; 25 487–90.
| Determining the true burden of general practice patients in the emergency department: getting closer.Crossref | GoogleScholarGoogle Scholar | 24308612PubMed |
[13] Freed GL, Gafforini S, Carson N. Age-related variation in primary care type presentations to emergency departments. Aust Fam Physician 2015; 44 584–8.
[14] Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 377–81.
| Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support.Crossref | GoogleScholarGoogle Scholar | 18929686PubMed |
[15] Robinson C, Verrall C, Houghton L, Zeitz K. Understanding the patient journey to the emergency department – a South Australian study. Aust Emerg Nurs J 2015; 18 75–82.
[16] Freed GL, Sewell J, Spike N, Moran L, Brooks P. Changes in the demography of Australia and therefore general practice patient populations. Aust Fam Physician 2012; 41 715–9.
| 22962651PubMed |
[17] Benahmed N, Laokri S, Zhang WH, Verhaeghe N, Trybou J, Cohen L, De Wever A, Alexander S. Determinants of nonurgent use of the emergency department for pediatric patients in 12 hospitals in Belgium. Eur J Pediatr 2012; 171 1829–37.
| Determinants of nonurgent use of the emergency department for pediatric patients in 12 hospitals in Belgium.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3s%2FltVKlug%3D%3D&md5=883fcec4ac0bee57e1f1567bc587d80dCAS | 23064744PubMed |
[18] Nagree Y, Camarda VJ, Fatovich DM, Cameron PA, Dey I, Gosbell AD, McCarthy SM, Mountain D. Quantifying the proportion of general practice and low-acuity patients in the emergency department. Med J Aust 2013; 198 612–5.
| Quantifying the proportion of general practice and low-acuity patients in the emergency department.Crossref | GoogleScholarGoogle Scholar | 23919709PubMed |
[19] Rinderknecht AS, Ho M, Matykiewicz P, Grupp-Phelan JM. Referral to the emergency department by a primary care provider predicts severity of illness. Pediatrics 2010; 126 917–24.
| Referral to the emergency department by a primary care provider predicts severity of illness.Crossref | GoogleScholarGoogle Scholar | 20956418PubMed |
[20] Scolnik D, Keogh K, Tuffman A, Palombo A, Sam J, Stephens D, Atenafu E. Parents may know best! A pilot study suggests that children of parents who do not have contact with health care professionals before attending the emergency department are triaged as more urgent. Paediatr Child Health 2011; 16 25–8.
| 22211069PubMed |
[21] Myers P. Management of minor medical problems and trauma: general practice or hospital? J R Soc Med 1982; 75 879–83.
| 1:STN:280:DyaL3s%2FlvFCnug%3D%3D&md5=a39c8f05e4798bda00d4586b50abf5bfCAS | 7143339PubMed |
[22] Stanley R, Zimmerman J, Hashikawa C, Clark SJ. Appropriateness of children’s nonurgent visits to selected Michigan emergency departments. Pediatr Emerg Care 2007; 23 532–6.
| Appropriateness of children’s nonurgent visits to selected Michigan emergency departments.Crossref | GoogleScholarGoogle Scholar | 17726411PubMed |
