Most patients attending a 'walk-in' clinic at Red Cross War Memorial Children's Hospital could safely be managed at primary care level.

OBJECTIVES

(i) To ascertain what proportion of patients attending the general medical outpatient service at Red Cross War Memorial Children's Hospital (RXH) could safely be managed at peripheral primary care facilities; and (ii) to measure the effect of the introduction of free health care for children under 6 years of age on requirements for levels of care ranging from home to super-specialist referral centres.

DESIGN

Prospective survey of patients attending on a stratified, randomised sample of 7 days in March 1994 (N = 1 962) and again in November 1994 (N = 1 404)-before and after the introduction on 6 June 1994 of free care for children under 6 years of age.

SETTING

The general outpatient department of an academic/referral children's hospital.

PATIENT SELECTION

All patients attending the outpatient department on the study days (7h00 to 6h59 the following day), excluding those who were referred, returning for follow-up, attending a specialist clinic or attending the surgical outpatient department. QUESTIONNAIRE: The questionnaire completed by medical officers recorded the following: patient's name, folder number, date and time of arrival, whether referred, clinic, treating doctor, disposal, diagnoses, home suburb and the level of care required: (i) home: (ii) clinic without a doctor; (iii) clinic with a doctor; (iv) hospital with non-specialists; (v) hospital with general paediatricians; or (vi) super-specialist hospital.

MAIN RESULTS

In March 1994 the percentages of unreferred patients requiring the 6 levels of care defined for the study were 0.3, 25, 62, 8, 3 and 1, respectively. In November 1994 the percentages were 4, 41, 43, 8, 4 and 1. The graph of the number of patients seen at the outpatient department each month shows a large month-to-month variation but the trend is clearly towards an increase.

CONCLUSIONS

The general medical outpatient department at RXH provides care to a large number of children, 48% of whom are unreferred. Of the unreferred patients 95% could be treated (more appropriately for the health services and more conveniently for their families) at a local primary health care facility. The situation has been aggravated by the introduction of free care for children under 6 years of age, who constitute 83% of the unreferred workload.