A service evaluation of general paediatric caseload

ABSTRACT

BackgroundIn the literature there is currently little data regarding general paediatric caseload. There are some reports of acute attendances, ward admissions and outpatient clinics, however most of these are from the 1990’s and early 2000’s with limited recent data available. The caseload within the general paediatric service has changed over the last 10–20 years and there have been recent changes due to COVID-19.ObjectivesTo describe general paediatric caseload at University Hospital Southampton (UHS) including emergency department (ED) attendances, ward admissions and outpatient clinic appointments in order to contribute to local service improvements, national projects and research planning.MethodsData was collected for all patients under the age of 18 years. ED and ward data were collected retrospectively, the clinic data was collected both prospectively and retrospectively. Analysis was carried out using Microsoft Excel.ResultsBetween 11thSeptember 2019 and 10th September 2020, 22,940 patients attended the ED. The top 3 presenting complaints were shortness of breath (10.8%), head injury (9.7%) and fever (9.5%) and the top 3 diagnoses (made by a doctor) were ‘no abnormality detected/no diagnosis recorded’ (21.9%), URTI (6.6%) and closed fracture (5.6%). In the 12–17-year-old age group, mental health issues were the 4th most common diagnosis (8.4%). Over the same year, 3212 patients were admitted to wards under general paediatrics. The top reason for admission was viral infection for stays less than 24 hours (16.3%) and 24–72 hours (13.8%) and acute bronchiolitis (20.9%) for stays over 72 hours. The median length of stay was 1 day, and the most common length of stay was 0 days. Over 8 weeks of outpatient clinics (September-October 2020) there were 476 appointments. The top 3 reasons for attendance were constipation (8.2%), food allergies/intolerances (5.9%) and abdominal pain (4.2%). 16.3% of appointments were unattended.ConclusionsThis is the first report of the full service provided by the general paediatric department at UHS, identifying common conditions presenting to the service. There may be a number of reasons why the final diagnosis made in ED was most commonly ‘no abnormality detected’. These include patients’ symptoms easing prior to consultation and miseducation, where the patients attend for a reason perceived to be concerning, however the child is found to be well. Review of current guidance has shown a lack of information available for some common conditions and developing new pathways of care may be beneficial for clinicians and families. Additional targeted work and focussed education into these areas may lead to improvements in care. The data can be used to help inform further research projects, as well as to develop services within local healthcare systems, improving the management of patients presenting with conditions that could be dealt with outside a hospital setting.