451 Children's emergency department review clinic: what we have learnt in the covid-19 pandemic. Issue 12 (23rd November 2020)

• Record Type: Journal Article
• Authors: Munday, Charlotte; Jain, Neha; Harrington, Seamus; Darvill, Benjamin; Perry, Sophie; Irwin, Alice; Deibel, Francesca; Turck, Richard; Barber, Clarissa
• Is Part Of: Emergency medicine journal. Volume 37:Issue 12(2020)
• Page Start: 852
• Page End: 852
• Publication Date: 2020-11-23
• Subjects: Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emj-2020-rcemabstracts.54
• Languages: English
• ISSNs: 1472-0205

Abstract

Abstract : Aims/Objectives/Background: The Children's Emergency Department (CED) in the Bristol Royal Hospital for Children (BRHC) runs 'Review Clinics' by a Paediatric Emergency Consultant. These were suspended in March 2020 due to the Covid-19 pandemic and new patient pathways were put in place. Our aim was to assess the effectiveness of these pathways and to evaluate if they should continue once the pressures of Covid-19 have eased. Methods/Design: We reviewed all the attendances to the ED Review Clinic over a six-week period in 2019 and identified common conditions that are seen in this clinic – abscesses, cellulitis, scaphoid fracture, toddler fracture, limp, headache, peri-orbital cellulitis, torticollis, and neck lumps (accounting for 66% of all attendances). We then identified all of the ED attendances with these conditions over the same six-week period during the Covid-19 pandemic and performed a service review using medical notes. Results/Conclusions: All children presenting with a limp during the Covid-19 pandemic were discharged with a leaflet and advised to return in one week if the limp persisted. None of them re-attended. Scaphoid and toddler fractures that presented during the Covid-19 pandemic were followed-up by Orthopaedics with a combination of telephone and face-to-face reviews. The toddler fractures were put into soft casts to be removed at home - 93% of parents were happy to do this. Orthopaedic review was quicker than the previous ED Review Clinic (an average of 63 hours compared to 216 for scaphoid fractures and 67 hours compared to 235 for toddler fractures). The results suggest that ED Review Clinics can and should change. Children with a limp can be sent home safely with clear advice. There is a greater role for telephone reviews, in particular, for injuries such as toddler fractures. This would be quicker, less time-consuming for patients, parents and physicians and more cost effective for the department.