Informing diversion strategy: A comparison of parent and general practitioner-referred paediatric patients presenting to a metropolitan hospital.

Abstract

To determine whether the characteristics and outcomes of parent-referred children differ substantially from general practitioner (GP)-referred children attending a metropolitan ED. Prospective cross-sectional observational study of consecutive patients aged less than 16 years of age attending a mixed adult and paediatric metropolitan teaching hospital ED in Melbourne. Data collected included patient characteristics (age, sex, arrival mode and triage category) and outcomes (admission, specialty consultation, treatment time >1 h, intravenous or nasogastric therapy, procedural sedation, procedures, imaging studies and pathology collection). The outcome data of 4580 patients was analysed. Patients brought by parents directly to the ED did not differ from patients referred by their GP in age, sex, or triage category, but were more likely to arrive by ambulance (13% vs 2%, P < 0.01). Low-urgency GP-referred children were more likely to require a procedure (22% vs 15%, risk difference [RD] 0.07, 95% confidence interval [CI] 0.02-0.13) and pathology tests (13% vs 8%, RD 0.05, 95% CI 0.01-0.1) than parent-referred children, but were similar for other outcomes. The proportion of low-urgency children who had no ED-specific care interventions was not significantly different between the groups (27% vs 32%, RD -0.06, 95% CI -0.11 to 0). Children brought to ED directly by their parents or carers did not differ substantially from GP-referred children in their characteristics or outcomes. The use of referral source and triage categories to determine patient suitability for diversion to general practice may need to be reconsidered.