Paediatrics, Royal United Hospitals Bath NHS Trust, Bath, UK.
BMJ Paediatr Open. 2021 Feb 22;5(1):e000892. doi: 10.1136/bmjpo-2020-000892. eCollection 2021.
We established a paediatric demand management (PDM) service in our paediatric department in 2017. The aim of this consultant-delivered service is to manage referrals more efficiently by providing active triage of all referrals, daily rapid access clinics and easily accessible advice for primary healthcare professionals. This study presents an evaluation of this service.
Mixed-methods service evaluation with analysis of data for every contact with the PDM service over a 2-year period. For each patient, the method of contact, reason for contact, presenting complaint and triage outcome were recorded. Feedback from general practitioners (GPs) and patients was gathered.
Data were analysed for 7162 patients. More than a quarter (2034; 28%) of all referrals were managed with advice only. Of the 4703 outpatient clinic referrals, 1285 (27%) were managed without a clinic appointment. More than half (54%) of the requests for paediatric assessment unit (PAU) admission were managed alternatively, typically with advice only or a rapid access clinic appointment. This has reversed the increasing trend of PAU admissions from primary care of preceding years. Financial analysis suggested the avoidance of these clinic appointments, and PAU admissions provided a substantial cost saving.
Our results indicate that the PDM service has succeeded in reducing unnecessary hospital attendances by managing patients more effectively and strengthening partnerships with primary care. The service has received overwhelmingly positive feedback from GPs. This service could be replicated in other Trusts and developed in the future to facilitate further management of paediatric cases in a primary care setting.
我们于 2017 年在儿科部门设立了儿科需求管理（PDM）服务。该顾问提供的服务旨在通过主动对所有转诊进行分类、每日快速就诊诊所和为初级保健医生提供便捷的咨询，更有效地管理转诊。本研究对该服务进行了评估。
采用混合方法服务评估，对 2 年来与 PDM 服务的每一次接触进行数据分析。对于每一位患者，记录联系方式、联系原因、就诊主诉和分诊结果。收集全科医生（GP）和患者的反馈。
对 7162 名患者的数据进行了分析。超过四分之一（2034 名；28%）的所有转诊仅通过提供建议进行管理。在 4703 名门诊转诊中，有 1285 名（27%）无需预约门诊即可管理。超过一半（54%）的儿科评估单位（PAU）入院请求通过其他方式进行管理，通常仅通过提供建议或快速就诊诊所预约。这扭转了前几年来自初级保健的 PAU 入院人数不断增加的趋势。财务分析表明，避免这些门诊预约和 PAU 入院可节省大量成本。
我们的结果表明，PDM 服务通过更有效地管理患者并加强与初级保健的合作，成功减少了不必要的医院就诊次数。该服务得到了全科医生的压倒性积极反馈。该服务可以在其他信托机构中复制，并在未来进一步发展，以促进在初级保健环境中进一步管理儿科病例。
