874 We are still not doing enough to adequately support parents in the postnatal period: acuity of presentations to A&E in under 6-month-olds

• Published in: Archives of disease in childhood 2022-08, Vol.107 (Suppl 2), p.A352-A352
• Main Authors: Ferretti, Lauren, Siracusa, Francesca, Benzaken, Tami, Lemaigre, Alexandra, Blair, Mitchel
• Format: Article
• Language: English
• Subjects: Abstracts; Acuity; Age; Bronchopneumonia; Emergency medical care; Emergency medical services; Ethnicity; Health care; Hospitals; Infant Care; Infants; Neonates; Parents; Patients; Pediatrics; Population studies; Respiratory tract; Respiratory tract diseases; Umbilical cord; Young Children
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2022-rcpch.567

AimsThere has been a 70% increase in infant attendance to A&E across England in the last decade, much of it non-urgent, highlighting the need to improve parental confidence and services for infant care.1 The purpose of this audit was to define the frequency of, and reasons for, such A&E attendances, with a view to informing the development of local targeted support for parents of young infants. Thus, aiming to reduce the number of non-urgent A&E attendances and improving the care and cost efficiency of the department.MethodsAn e-Audit of the A&E IT system indicated 264 presentations to our hospital Paediatric A&E in August 2021 by infants under 6 months of age. A random selection of 50 of these were analysed for multiple variables including presenting complaint, level of acuity at triage, duration of A&E visit, investigation (Y/N), treatment (Y/N), admission (Y/N), and diagnosis.Abstract 874 Table 1Summary of patient demographicsResultsData was collected from a varied sample of patients of different ages and ethnic backgrounds (see table 1). The vast majority were triaged as ‘4 - Standard level emergency care’ (n=37, 74%). 17/50 (34%) had an investigation performed and 6/50 (12%) received treatment. Only 10% (n=5) required admission, and 1 patient was transferred to a different hospital for a review by a surgical subspecialty. Common diagnoses included bronchiolitis, respiratory tract infection, and reflux. Almost a quarter of patients (22%, n=11) were coded as ‘well baby’ or ‘no abnormality detected’. Of these 11 attendances, the presenting complaint ranged from reduced feeding, umbilical cord queries, to bowels not opening. 9/11 were 32 days of age or less at presentation and none required admission or treatment. A fifth of presentations (n=20) occurred on a weekday during working hours (09:00-17:00). The duration of each visit to the A&E department ranged from 26 minutes to 357 minutes (median 153 minutes).ConclusionOur findings demonstrate that a significant proportion, one fifth, of presentations to paediatric A&E are low acuity concerns in infants less than 5 weeks of age, which do not require investigation, treatment, or admission to hospital. These observations support the need to review the effectiveness of services which provide parents with self-care advice and reassurance for common neonatal issues. This data has led us to trial a two-phased antenatal and postnatal educational intervention delivered by midwives, health visitors and paediatricia