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617 The children may have gone but children under 1 month have not. Emergency department attendances in under 1 month olds during the 2020 COVID-19 pandemic

Background Research during 2020 suggests UK Paediatric Emergency department (PED) attendances dropped by 30% at the start of the first National Lockdown (March 2020). Our PED (28,000 attendances (2019) vs 21,000 attendances (2020)) saw a similar drop in attendances but anecdotally noted babies under 1 month increased. Throughout 2020 many healthcare providers (including General practitioners (GP), Health Visitors (HV) and midwives) moved from routine ‘face to face’ (F2F) review to virtual contact, plus redeployment of staff/clinical spaces and alterations to care pathways. Strict rules on social distancing and reduced social interactions were enacted on a national level. Locally, COVID related pathways and cohorted areas evolved but all patients booked into PED as per pre-COVID practice. We sought to analyse attendances in this age group and institute changes using quality improvement (QI) methodology. Objectives Reduce the number of avoidable PED attendances of babies under 1 month. Methods PED attendances 01/01/2019 to 31/12/2020 of infants under 1 month were analysed. Attendances were plotted on a monthly run chart with a baseline median calculated on 2019 data. Discharge diagnoses for the first 6 months of 2020 were recorded and analysed to give an overview of attendance reasons and areas on which to focus interventions. An ‘avoidable attendance’ was classed as ‘feeding problem’ or ‘jaundice’ as these do not typically require specialist paediatric emergency medicine input. Monthly overall PED attendances and hospital live birth numbers 2019–2020 were noted. Interventions included multi-disciplinary team meetings with Maternity, Paediatrics and Safeguarding. Care pathways (hospital & community) were reviewed and extra resources allocated to maternal feeding & support. Results A total of 805 infants under 1 month attended PED January 2019 to December 2020, n=372 (2019) vs n= 433 (2020). The baseline median of monthly attendances under 1 month old was 29 patients per month (2019) vs 36 patients per month (2020). Live births were similar 5143 (2019) vs 5109 (2020). PED discharge diagnosis January to June 2020 (n= 224) showed 27% (n=61) due to ‘jaundice’ and 21% (n= 47) due to ‘feeding problems’ with none of these infants admitted. PED attendances under 1 month old dropped from a peak of 55 patients (July 2020) but has not dropped to consistently below baseline median. Alternative pathways to access services were not included in analysis. The increased number via PED might reflect the true number normally seeking healthcare input (e.g. HV, GP, Paediatrics and Maternity services) but an unintended consequence of COVID-19 related service alterations means PED is the default route for F2F review or parental support/reassurance. Separate in-depth analysis of 2020 hospital wide attendances under 1 month old suggests a wider system issue. Conclusions During 2020 under 1 month old PED attendances increased above the baseline of 29 patients to 36 patients per month despite overall PED attendances dropping 25% compared to 2019. Analysis suggests 50% were jaundice/feeding related. Interventions across our local healthcare system have yet to demonstrate a sustained and statistically significant drop below the baseline median. Local analysis continues and long-term targets on avoidable PED attendances may have merit.