Paediatric emergency department dog bite attendance during the COVID-19 pandemic: an audit at a tertiary children’s hospital

BackgroundResponses to the COVID-19 pandemic include strict public health measures, such as national lockdowns. During these measures, paediatric emergency department attendances have declined and the prevalence of presenting complaints has changed. This study sought to identify whether dog bite attendance and victim demographics changed during COVID-19 public health measures.MethodsAn audit was conducted of emergency department attendance data from a UK tertiary paediatric hospital between January 2016 and September 2020. Dog bite attendance and victim demographics were explored using χ2 tests and multivariable Poisson regression. The mean monthly percentage of attendance due to dog bites in 2020 was compared against predicted percentages based on previous years’ data.ResultsDog bite attendance rose in conjunction with the introduction of COVID-19 public health measures and reached a peak in July 2020 (44 dog bites, 1.3% of all attendances were due to dog bites). This was a threefold increase in dog bite attendance. By September 2020, attendance had returned to normal. The demographic profile of child dog bite victims remained the same. Boys had the highest attendance rates in 7–12 year-olds, girls in 4–6 year-olds. Girls showed higher attendance rates in the summer, while boys’ attendance rates were constant throughout the year. COVID-19 public health measures were associated with a 78% increase in attendance for boys and a 66% increase in girls.ConclusionsCOVID-19 national public health measures were associated with an increase in paediatric emergency department dog bite attendance, and may be due to increased child exposure to dogs via ‘stay at home’ orders and school closures. National lockdowns are likely to continue globally throughout the COVID-19 pandemic; this is likely to result in more dog bites. Urgent public health communication and injury prevention strategies are needed to help prevent these avoidable injuries.

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Paediatric emergency department attendances during COVID-19 and SARS in Singapore

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2020500 ◽

2021 ◽

Vol 50 (2) ◽

pp. 126-134

Author(s):

Ronald MR Tan ◽

Sashikumar Ganapathy ◽

Arif Tyebally ◽

Khai Pin Lee ◽

Shu-Ling Chong ◽

...

Keyword(s):

Public Health ◽

Emergency Department ◽

Absolute Number ◽

Hospital Inpatient ◽

Paediatric Hospital ◽

Paediatric Emergency Department ◽

Health Measures ◽

Paediatric Emergency ◽

Outbreak Period ◽

The Impact

Introduction: We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore. Methods: Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004). Results: Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January–July 2019, to 274 per day in January–July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January–July 2019 (19,629) to January–July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January–July 2019 and 21% in January–July 2020. Conclusion: Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally. Keywords: COVID-19, paediatric emergency department, public health measures, SARS

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Why did the children stop coming? Reasons for paediatric emergency department attendance decrease during the first wave of the COVID-19 pandemic in the United Kingdom: A qualitative study

10.1101/2021.03.30.21254661 ◽

2021 ◽

Author(s):

Matthew Breckons ◽

Sophie Thorne ◽

Rebecca Walsh ◽

Sunil Bhopal ◽

Stephen Owens ◽

...

Keyword(s):

Public Health ◽

Emergency Department ◽

United Kingdom ◽

Substantial Reduction ◽

Healthcare Services ◽

Urgent Care ◽

List Type ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

Health Messaging

AbstractObjectiveTo explore parent’s experiences and views relating to their use of children’s emergency healthcare services during the Covid-19 pandemic.DesignQualitative telephone interview study using in-depth interviews, based on the principles of grounded theory. Recorded, transcribed verbatim, managed in NVivo version 12, analysed by thematic analysis.SettingNorth East England, United Kingdom.ParticipantsParents of children aged 0-8 years.FindingsThree major themes emerged from the interview data: Risk to children and families, Sources of Information, and Making Healthcare-seeking Decisions. These themes encompassed a range of intellectual and emotional responses in the way that parents interpreted information related to Covid-19, and their sense of responsibility towards family and wider society.ConclusionsTogether these themes aid understanding of the changes in paediatric emergency department attendances reported in the early months of the Covid-19 pandemic in the UK. The analysis suggests that public health messaging directed at those seeking urgent care for children may be inadequate and lead to adverse consequences, the impacts of which require further study and refinement.What is known about the subjectFollowing lockdown, there was a substantial reduction in the number of children taken to unscheduled medical care across the countryDelays in presentation can impact on children’s healthIt is not known what parents’ views are on accessing emergency health services in a pandemic situationWhat this study addsParents had to weigh up a number of information sources before deciding on whether to take their child to hospitalPublic health messaging directed at those seeking urgent care for children may lead to a reduction in use of emergency healthcare servicesFuture lockdowns should implement focussed strategies, optimising use of emergency healthcare services, whilst avoiding harm.

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To GP or not to GP: a natural experiment in children triaged to see a GP in a tertiary paediatric emergency department (ED)

BMJ Quality & Safety ◽

10.1136/bmjqs-2017-006605 ◽

2017 ◽

Vol 27 (7) ◽

pp. 521-528 ◽

Cited By ~ 4

Author(s):

Laurie Smith ◽

Yajur Narang ◽

Ana Belen Ibarz Pavon ◽

Karl Edwardson ◽

Simon Bowers ◽

...

Keyword(s):

Emergency Department ◽

Natural Experiment ◽

Care Pathway ◽

Waiting Times ◽

Sensitivity Analyses ◽

Antibiotic Prescribing ◽

Paediatric Hospital ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

The Impact

ObjectiveTo evaluate the impact of integrating a general practitioner (GP) into a tertiary paediatric emergency department (ED) on admissions, waiting times and antibiotic prescriptions.DesignRetrospective cohort study.SettingAlder Hey Children’s NHS Foundation Trust, a tertiary paediatric hospital in Liverpool, UK.ParticipantsFrom October 2014, a GP was colocated within the ED, from 14:00 to 22:00 hours, 7 days a week. Children triaged green on the Manchester Triage System without any comorbidities were classed as ‘GP appropriate’. The natural experiment compared patients triaged as ‘GP appropriate’ and able to be seen by a GP between 14:00 and 22:00 hours (GP group) to patients triaged as ‘GP appropriate’ seen outside of the hours when a GP was available (ED group). Intention-to-treat (ITT) analysis was used to assess the main outcomes.Results5223 patients were designated as ‘GP appropriate’—18.2% of the total attendances to the ED over the study period. There were 2821 (54%) in the GP group and 2402 (46%) in the ED group. The median duration of stay in the ED was 94 min (IQR 63–141) for the GP group compared with 113 min (IQR 70–167) for the ED group (p<0.0005). Using the ITT analysis equivalent, we demonstrated that the GP group were less likely to: be admitted to hospital (2.2% vs 6.5%, OR 0.32, 95% CI 0.24 to 0.44), wait longer than 4 hours (2.3% vs 5.1%, OR 0.45, 95% CI 0.33 to 0.61) or leave before being seen (3.1% vs 5.7%, OR 0.53, 95% CI 0.41 to 0.70), but more likely to receive antibiotics (26.1% vs 20.5%, OR 1.37, 95% CI 1.10 to 1.56). Sensitivity analyses yielded similar results.ConclusionsIntroducing a GP to a paediatric ED service can significantly reduce waiting times and admissions, but may lead to more antibiotic prescribing. This study demonstrates a novel, potentially more efficient ED care pathway in the current context of rising demand for children’s emergency services.

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Parents’ and carers’ impression of “quality” within a Paediatric Emergency Department

BMC Pediatrics ◽

10.1186/s12887-021-02752-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Brendan Lacey ◽

Adam West ◽

Simon Craig

Keyword(s):

Emergency Department ◽

Quality Of Care ◽

Delphi Study ◽

Quality Measures ◽

Quality Measure ◽

Free Text ◽

Paediatric Hospital ◽

Paediatric Emergency Department ◽

Paediatric Emergency

Abstract Background Quality improvement systems are needed to overcome the ‘Quality Gap’ – difference between evidence-based guidelines and the care delivered. While there are a large array of potential quality assurance measures exists in the Paediatric Emergency Department, parent’s/carer’s perception of these is unknown. This study aimed to identify what ‘quality of care’ means to parents/carers of Paediatric Emergency Department (PED) patients, further determine which aspects of these are most important to them. Also, to identify which of the existing PED quality measures are most important to parents/carers, and their preferred method of providing feedback. Methods A Modified Rand-Delphi study was performed with parents/carers as the expert group and consensus was obtained from them via three web-based surveys. All parents/carers of children attending a tertiary paediatric hospital during six-week in winter were eligible– no exclusions. Quality measures scoring at least 7 on a 9-point Likert scale during the final survey were considered “very important”, while those scoring at least an 8 were considered “extremely important”. Results One hundred four parents/carers responded from a total of 1095 participants. Parents/carers generated 527 free text entries, to the initial survey on what ‘quality of care’ means. These were mapped to 48 quality measure which they ranked on subsequent surveys. Eighteen quality measures were considered very important by at least 90% of respondents. Of these, six were considered extremely important by at least 70% of respondents: ‘Thorough medical assessment’ (84%); ‘A triage system’ (84%); ‘Experienced and knowledgeable staff that are skilled in paediatrics’ (77%); ‘Resources and equipment available to provide care’ (72%); and ‘Clear follow up plans and reviews that are communicated and scheduled’ (72%). Parents/carers considered existing quality measures as important with ‘timely treatment of a critical condition’ as the most important. Most participants preferred to provide anonymous feedback (N = 69, 66%), online (N = 77, 72%) after discharge (N = 82, 70%). Conclusion We have elicited what ‘quality of care’ means to parents/carers, and which aspects are most important to them. Parents/carers consider commonly used PED quality measure as very important. However, they are less important than outcomes generated by themselves. Further parents/carers in this study preferred to provide feedback that was anonymous and electronically distributed after they leave the ED.

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Point-of-care testing in a high-income country paediatric emergency department: a qualitative study in Sweden

BMJ Open ◽

10.1136/bmjopen-2021-054234 ◽

2021 ◽

Vol 11 (11) ◽

pp. e054234

Author(s):

Reza Rasti ◽

Johanna Brännström ◽

Andreas Mårtensson ◽

Ingela Zenk ◽

Jesper Gantelius ◽

...

Keyword(s):

Emergency Department ◽

Point Of Care ◽

Healthcare Providers ◽

High Income ◽

Paediatric Hospital ◽

Clinical Patient ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

Resource Limited ◽

Local Setting

ObjectivesIn many resource-limited health systems, point-of-care tests (POCTs) are the only means for clinical patient sample analyses. However, the speed and simplicity of POCTs also makes their use appealing to clinicians in high-income countries (HICs), despite greater laboratory accessibility. Although also part of the clinical routine in HICs, clinician perceptions of the utility of POCTs are relatively unknown in such settings as compared with others. In a Swedish paediatric emergency department (PED) where POCT use is routine, we aimed to characterise healthcare providers’ perspectives on the clinical utility of POCTs and explore their implementation in the local setting; to discuss and compare such perspectives, to those reported in other settings; and finally, to gather requests for ideal novel POCTs.DesignQualitative focus group discussions study. A data-driven content analysis approach was used for analysis.SettingThe PED of a secondary paediatric hospital in Stockholm, Sweden.ParticipantsTwenty-four healthcare providers clinically active at the PED were enrolled in six focus groups.ResultsA range of POCTs was routinely used. The emerging theme Utility of our POCT use is double-edged illustrated the perceived utility of POCTs. While POCT services were considered to have clinical and social value, the local routine for their use was named to distract clinicians from the care for patients. Requests were made for ideal POCTs and their implementation.ConclusionDespite their clinical integration, deficient implementation routines limit the benefits of POCT services to this well-resourced paediatric clinic. As such deficiencies are shared with other settings, it is suggested that some characteristics of POCTs and of their utility are less related to resource level and more to policy deficiency. To address this, we propose the appointment of skilled laboratory personnel as ambassadors to hospital clinics offering POCT services, to ensure higher utility of such services.

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Delivery of a multi-focus public health intervention in the paediatric emergency department: a feasibility and acceptability pilot study

BMJ Open ◽

10.1136/bmjopen-2020-047139 ◽

2021 ◽

Vol 11 (12) ◽

pp. e047139

Author(s):

Rachel Isba ◽

Rhiannon Edge

Keyword(s):

Public Health ◽

Emergency Department ◽

Dental Health ◽

Public Health Intervention ◽

Health Intervention ◽

Secondary Outcome ◽

Public Health Medicine ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

Frequent Attendance

ObjectiveThe objective was to see if it was feasible and acceptable to deliver a brief public health intervention as part of an attendance at the paediatric emergency department (PED).DesignA feasibility and acceptability pilot design was used as there is no previous work done in this clinical area, population or using this approach in children and young people (CYP). Quantitative and qualitative data were collected. Follow-up was at 1 week and 1, 3 and 6 months.SettingThis pilot took place in a single PED in Greater Manchester, England.ParticipantsParticipants were CYP (under 16 years old) and their parents/carers, attending the PED during a 2-week recruitment period in September 2019.InterventionsThe intervention was a brief conversation with a Consultant in Paediatric Public Health Medicine, using Screening, Brief Intervention and Referral to Treatment. The intervention focused on vaccination, dental health, household smoking and frequent attendance.Primary and secondary outcome measuresThe primary outcome measure was information to support the effective development of a larger-scale study. Secondary outcomes were measures of health, again intended to provide additional information prior to a larger study.ResultsThirty CYP were recruited from 29 households. Sixty per cent of CYP triggered at least one screening question, most commonly household smoking and dental health. It was not possible to accurately assess frequent attendance and 97% of parents/carers stated that they thought their child or young person was fully vaccinated for their age, which is likely to be an over-estimate.ConclusionsIt is feasible to deliver a brief public health intervention in the PED and such an approach is acceptable to a variety of stakeholders including CYP, parents/carers and nursing staff. The pilot revealed issues around data quality and access. Future work will focus on vaccination and dental health.

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