244\u2005Implementing a telephone triage service for acute general paediatric referrals from primary care in a tertiary paediatric hospital

Abstract

BackgroundThe General Paediatric Service at our Hospital is extremely busy, often with more than 70 inpatients under the team each day during months of peak activity and over 40 new acute telephone referrals from Primary Care daily. The number of children attending acute services at the hospital has been increasing annually and the Emergency Department will often have more than 300 attendances in 24 hours in winter months. This activity level means there is a significant pressure on inpatient beds and effective patient flow through the hospital is essential. During the ongoing COVID19 pandemic, there has been pressure on acute NHS services, which has driven the need for new innovative ways of working.ObjectivesWe aimed to ensure that all acute referrals to the General Paediatric Service were triaged via telephone by a senior paediatric clinician (registrar or consultant). The primary aim of this service was to ensure that children were streamed to the appropriate location, to be seen by the appropriate team at the appropriate time. Secondary aims included improving the interface with primary care and instigating pre-hospital management for patients streamed into outpatient services.MethodsA General Paediatric telephone triage was introduced, operating for 12 hours each day (9am–9pm) 7 days per week. This service was staffed by senior paediatric clinicians and received calls from GP surgeries, NHS24 and COVID assessment centres. The clinician delivering the service discussed all acute referrals with referring clinician and was able to offer immediate advice with regard to most appropriate management. Data from each acute referral received including the outcome of the call was collected prospectively.ResultsData has been collected for 2834 acute referrals to our Paediatric Telephone Triage service from its establishment in March 2020. Of these calls, 57% (1627) had been seen in a face-to-face consultation with their GP prior to referral.We found that following telephone triage with referring clinician acute attendance and assessment was not required in 972/2834 (34%) cases. In 447/2834 (16%) cases it was felt that the child did not require assessment in secondary care at all and the GP was provided with advice in relation to ongoing management. In 128/2834 (4.5%) referrals the child was streamed into General Paediatric clinic (including utilisation of rapid access and urgent telephone consultations). The remaining calls resulted in patients being seen in primary care facilities (including COVID assessment centres) or being streamed to other specialities within the hospital.ConclusionsImplementing a telephone-based triage service for paediatrics has reduced unnecessary unscheduled care attendances. Primary Care access to a senior paediatric clinician by telephone has had a positive impact on the number of children being referred for acute assessment. Utilisation of Rapid Access Clinics and urgent Telephone Consultations can help ensure that children are seen in a timely fashion and help reduce pressure on front door services.