The term ‘acute’ is not synonymous with emergency but this better describes the needs of the 4.42 million children1 (age 0-14 years) who presented to emergency departments in 2017-2018. This huge expansion of ‘emergency’ presentations has taken place relatively quickly (in 2008-2009 there were 2.66 million) and has challenged traditional paediatric services. A decade ago, an unwell child would have presented to their general practitioner (GP) and if necessary referred to see a general paediatrician on an ‘acute’ take. Pathways to emergency care are now much more plentiful, reflecting attempts to both mitigate demand on emergency departments and the emphasis on patient choice in health policy. Attendances for children (age 0-14 years) have remained at about 20 of all emergency presentations for over a decade1; however, short stay admission (less than 24 hours) is becoming the predominant outcome for most referrals.2 While new pathways into the system have opened up (telephone services, urgent care hubs, etc), this has led to regional variation and confusion for parents.3 We still have old models of professional hierarchies which gate-keep access to secondary care and are often dependent on writing letters (although electronically) with little or no focus on prevention. This negates an important continuum emphasised as early as the 1920 Dawson Report (figure 1) and continues to still present a challenge to policymakers today.
展开▼
