The changing utilization of a children’s emergency department

Objective To assess the changing pattern of attendance at an emergency department in a children’s hospital.

Design A retrospective review of the attendance register from 1 September 1986 to 31 August 1998.

Setting Derbyshire Children’s Hospital, Derby, serving a mixed urban and rural population within the National Health Service.

Measurement Total number of attendances and admissions each year. For one week in February and August each year: age and case mix assessed. For the period 1994–98: the source of the referral and the outcome of patients referred by their General Practitioner (GP).

Results Over the study period: a rise in attendances from 4853 to 8796; no change in the total number admitted to hospital. A decline in the proportion admitted from 56 to 32%. For the period 1994–98: no change in the number of patients referred by their GP; an increasing number of self-referrals. Overall age mix: age < 1 year, 27%; age 1–4 years, 42%; age 5–12 years, 26%; age > 13 years, 5%. Overall case mix: medical, 73%; surgical, 9%; trauma/minor injuries, 18%.

Conclusion An important change has occurred in the utilization of our paediatric emergency department with increasing numbers of children seeking hospital assessment, largely via self-referrals, but not requiring hospital admission.

Implications for practice Future planning and deployment of paediatric resources need to take account of the change in use of hospital emergency services.