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GP95 A prospective audit of paediatric attendances at a regional general emergency department and paediatric assessment unit

Introduction Cavan General Hospital’s Paediatric Assessment Unit (PAU) was the first of its’ kind in the Republic of Ireland. The PAU was opened in 2011 with the aim of addressing the growing number of urgent paediatric attendances. It deals with all urgent medical and surgical cases and provides some scheduled care for routine procedures. Published studies have indicated that PAU-type units can improve efficiency, reduce admission rates and overall costs. Aim The PAU’s Operational Policy mandates regular monitoring of activity relative to a variety of key performance indicators. The aim of this audit was to review and contrast ED/PAU activity in order to assess the impact of the PAU. Performance standards were based on the ICTS’s recommended wait-times and the RCEM’s four-hour standard for outcome decision. Methods Overall trends in paediatric emergency activity over the period from 2009 to 2018 were reviewed. A three-month prospective audit was conducted of all attendees of CGH’s ED and PAU less than 16 years old from the 1st of September to the 30th November of 2018. The key performance indicators assessed were time to triage, compliance with recommended wait-times, admission rates and compliance with the four-hour standard. Results were compared with those of a similar audit conducted over the same season in 2009. Statistical analysis was performed using Microsoft Excel 2010. Results Between 2013 and 2018 urgent attendances increased by 46.8% from 5,487 to 8,059. During this period PAU activity increased by 13.4% yet overall paediatric admissions rates fell from 24.3% to 17.9%. Over the three-month audit period 1,764 attendances were recorded. Compared to 2009 more patients in 2018 were triaged within 15 minutes of arrival (60% vs 45%, P<0.001) and more were seen within 1 hour of triage (80% vs 75%, p<0.01). In comparison to ED attendees, those attending the PAU were more likely to be triaged within 15 minutes (69% vs. 47%, p<0.001), had higher compliance to recommended wait-times (89% vs. 65%, p<0.001), had lower rates of admissions (21% vs. 26%, p<0.05) and had higher compliance to the four-hour standard (94% vs. 88%, p<0.001). Conclusions Urgent paediatric referral numbers in our region have shown a significant increase between the years 2013 to 2018. However the percentage of these referrals admitted to hospital has reduced. Since the PAU has opened there has been an improvement in key performance indicators and there is, at present, better compliance to accepted standards.