Evidence map›Paper›PMID 28971883›Full record

ArticleBMJ quality & safety2018

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

Laurie Smith, Yajur Narang, Ana Belen Ibarz Pavon, Karl Edwardson, Simon Bowers, Katharine Jones, Steve Lane, Mary Ryan, David Taylor-Robinson, Enitan Carrol

Open access · hybridAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ quality & safety, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
1.4field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 14 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
  4. Observational
  5. Management of non-urgent paediatric emergency department attendances by GPs: a retrospective observational study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2021
    Observational
  6. Article
  7. Review
  8. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 1 country.

Laurie Smith *Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
Yajur Narang *Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
Ana Belen Ibarz PavonInstitute of Infection and Global Health, University of Liverpool, Liverpool, UK.
Karl EdwardsonAlder Hey Children's NHS Foundation Trust, Liverpool, UK.
Simon BowersLiverpool Clinical Commissioning Group, Liverpool, UK.
Katharine JonesUrgent Care 24, Liverpool, UK.
Steve LaneDepartment of Biostatistics, University of Liverpool, Liverpool, UK.
Mary RyanAlder Hey Children's NHS Foundation Trust, Liverpool, UK.
David Taylor-Robinson *Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
Enitan Carrol *Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.ORCID 0000-0001-8357-7726
University of Liverpool · GBAlder Hey Children's NHS Foundation Trust · GBBristol Clinical Commissioning Group · GB

Funding

Medical Research Council MR/P008577/1
6 · The paper itself

Abstract

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.

Indexed as

AdolescentAnti-Bacterial AgentsChecklistChildChild, PreschoolDrug UtilizationEmergency Service, HospitalEnglandFemaleGeneral PractitionersHospitals, PediatricHumansInfantIntention to Treat AnalysisLength of StayMaleAnti-Bacterial Agentsemergency departmentprimary carequality improvement methodologies

Identifiers

PMID28971883
PMCPMC6047147
OpenAlexW2758767505

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.