MOST PATIENTS ATTENDING A WALK-IN CLINIC AT RED-CROSS WAR MEMORIAL CHILDRENS-HOSPITAL COULD SAFELY BE MANAGED AT PRIMARY-CARE LEVEL

Objectives. (i) To ascertain what proportion of patients attending the general medical outpatient service at Red Cross War Memorial Children 's Hospital (RXH) could Safely be managed at peripheral primary care f acilities; and (ii) to measure the effect of the introduction of free health care for children under 6 years of age on requirements for leve ls of care ranging from home to super-specialist referral centres. Des ign. Prospective survey of patients attending on a stratified, randomi sed sample of 7 days in March 1994 (N = 1 962) and again in November 1 994 (N = 1 404) - before and after the introduction on 6 June 1994 of free care for children under 6 years of age. Setting. The general out patient department of an academic/referral children's hospital. Patien t selection. All patients attending the outpatient department on the s tudy days (7h00 to 6h59 the following day), excluding those who were r eferred, returning for follow-up, attending a specialist clinic or att ending the surgical outpatient department. Questionnaire. The question naire completed by medical officers recorded the following: patient's name, folder number, date and time of arrival, whether referred, clini c, treating doctor, disposal, diagnoses, home suburb and the level of care required: (i) home; (ii) clinic without a doctor; (iii) clinic wi th a doctor; (iv) hospital with non-specialists; (v) hospital with gen eral paediatricians; or (vi) super-specialist hospital. Main results. In March 1994 the percentages of unreferred patients requiring the 6 l evels of care defined for the study were 0.3, 25, 62, 8, 3 and 1, resp ectively. in November 1994 the percentages were 4, 41, 43, 8, 4 and 1. The graph of the number of patients seen at the outpatient department each month shows a large month-to-month variation but the trend is cl early towards an increase.Conclusions. The general medical outpatient department at RXH provides care to a large number of children, 48% of whom are unreferred. Of the unreferred patients 95% could be treated ( more appropriately for the health services and more conveniently for t heir families) at a local primary health care facility. The situation has been aggravated by the introduction of free care for children unde r 6 years of age, who constitute 83% of the unreferred workload.