The rapid access paediatric clinic: a way to reduce inappropriate admissions to hospital.

With documented evidence of increased numbers of paediatric admissions to a reduced number of beds, it is important that children are admitted to hospital for appropriate reasons. Some hospitals have set up rapid access or emergency consultation clinics to try to avoid unnecessary paediatric admissions. This study examined the presenting problem of 451 patients referred by general practitioners (GPs) to the paediatric emergency clinic at Southampton General Hospital over a five month period, and the outcome for the children in terms of investigation, admission or follow-up. The most common presenting problems were gastrointestinal (26.8%), respiratory (22.8%) or infectious (19.1%). Cough or "chestiness" was the single most common presenting symptom. A total of 328 investigations was performed. After the clinic visit, 35.3% of children were discharged, 18.8% were asked to return to the clinic for a follow-up visit and 19.1% were admitted to the ward. 16.4% were given a future paediatric outpatient appointment, 7.3% were referred for specialist opinion in a different speciality, and 6.7% were advised to return to the GP for follow-up. The authors consider that the emergency paediatric clinic is appropriately used by GPs referring acute and sub-acute problems and believe that local satellite clinics run along similar lines would be welcomed by GPs, health visitors and parents. Although there is little documented evidence that rapid access paediatric clinics reduce admission, the authors consider that unnecessary admission was avoided for many of the children seen in the emergency clinic. Prospective studies are needed to confirm this.