G288(P) Evaluation of patient admissions through a paediatric emergency department at a central hospital in a resource-poor setting

Aims To evaluate patient attendance, admission rates and use of the resuscitation room in a Paediatric Emergency Department at a central hospital in a resource-poor country. To identify how trends have changed and if there is a need to change the clinical environment to match the requirements of patients seen. Methods Data was collated from departmental daily summary books, computerised and analysed to evaluate attendance, admission and use of the resuscitation room. A 1 month period was analysed in more depth using additional resuscitation room and admission record books to review patient demographics and diagnoses. Results Records were collected from September 2014 – May 2017 and grouped to identify year-on-year trends. Some dates had missing information so averages have been used to account for this. There are approximately 40 000 total attendances and 11 000 admissions per year through the department. Whilst the number of admissions overall appears to be falling, the rates of those admitted through the resuscitation room appear to be increasing, from an average of 17% in 2014/15% to 22% in 2016/17. In 2016/17 the monthly percentage of admissions through the resuscitation room ranged from 17%–30%. In evaluating a 1 month (January 2017) snapshot of 1007 admitted patients, over a quarter were under the age of 12 months. 24.9% patients admitted during this month were seen in the resuscitation room and the most common diagnoses of these patients were Malaria and/or Anaemia, Bronchiolitis and Pneumonia. Conclusion Admissions through the department appear to be decreasing, but the proportion of sick children being assessed in the resuscitation room is increasing. This may reflect that patients with milder illnesses are now being managed better in the district hospitals, with only those who are exceedingly sick or requiring specialist services being referred. This review identified that approximately 22% of paediatric patients admitted are currently coming through the three-bedded resuscitation room, and due to the severity of their symptoms and the amount of clinical care required, this certainly identifies a justification for redesign and expansion of this resuscitation room.