Avoiding inappropriate paediatric admission: facilitating General Practitioner referral to Community Children’s Nursing Teams

Table 1 Case Study Population and Service Characteristics

		Case Study
PCT Population		A	B	C
Population¹	<15 years old, n (%)	34,300 (18.7)	45,100 (18.1)	38,000 (17.2)
Deprivation²		17.9	34.5	45.9
Child Well-being³		7.5	20.4	45.8
Local Healthcare Economy
Services
Hospital(s)		District General	District General	Tertiary Children’s (closed mid-2009), District General
ED		Yes	Yes	Yes (combined)
OAU		No	Yes	Yes (combined)
Walk-in Centre (n)		Yes (2)	No	Yes (2)
Emergency Admission Rate at Local Hospital^‡4		42.3	52.3	57.7
ED attendance rate at Local Hospital^‡5		376.2	385.1	386.2
GPs per 100,000 children <15⁶		306.4	295.2	416.9
CCNT
Base (Organisation)		Community (PCT)	Hospital (Acute Trust)	Community (PCT)
Number of years established at beginning of study		3	14	2
Disease focus		Acute and Chronic	Acute (and End of Life)	Acute (separate complex needs team)
Referrals⁷	n	923	3,024	3,930
Source (%)	GP	7.3	16.0	2.0
	GP out-of-hours	0.2	-	-
	Walk-in-Centre	5.2	-	0.7
	Parent/Carer	2.1	1.5	1.8
	ED	1.1	26.0	86.7
	OAU	-	15.8	86.7
	Ward	77.0	35.2	-
	Other	7.1	5.5	8.8
Workforce⁸ FTE	n	13.8	14.4	10.0
	per 1,000 children <15	0.40	0.32	0.26
Hours of operation		Mon to Fri 08:00 to 20:00; Sat/Sun/Bank Holidays 08:00 to 18:00	Mon to Sun 08:00 to 20:00	Mon to Sun 08:00 to 22:00
CCNT referral rate per 1,000 children <15⁹		26.9	67.1	103.4

Notes:
^‡ Local Hospital is defined as the hospital to which the greatest percentage of children resident in the PCT attend.
Data sources:
¹ Office for National Statistics (ONS) mid-year estimates 2008.
² Percentage of people living in the most deprived quintile of the Index of Multiple Deprivation 2007 (England average: 19.9%) (Source: APHO and DH Health Profile 2009).
³ Percentage of Lower Super Output Areas in Lowest quintile of the national distribution (Source: Local Index of Child Well-being 2009).
⁴ Emergency Admission Rate for three commonest medical presentations at EDs (i.e., breathing difficulty, feverish illness, diarrhoea) per 1,000 children aged 0–14 resident in the study area (Source: Hospital Episode Statistics 2006/07).
⁵ ED attendance rate per 1,000 children aged 0–14 registered with a GP in the study area (Source: North West Strategic Health Authority Tactical Information Service 2007/08).
⁶ GPs per 100,000 children aged 0–14 (Source: The Information Centre for Health and Social Care 2009).
⁷ Annual Referrals (Source: CCNT routinely collected data 2009).
⁸ Full-time Equivalent workforce (Source: CCNT A, December 2009; CCNT B, March 2010; CCNT C, December 2009).
⁹ CCNT referral rate per 1,000 children aged 0–14 (Source: CCNT routinely collected data 2009; ONS mid-year estimates 2009).

ISSN: 2731-4553