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. Figure 1 Extract from the Dawson Report, courtesy of King's Fund. The reasons for these deficits in continuity and comprehensiveness are multifactorial. Certainly, it is likely the UK 2004 General Medical Services contract, which changed out of hours provision, affected care for children along with changing societal expectations in relation to managing simple illness. However, it is also the case that paediatricians have been slow to adapt to the ever-increasing demand for specialist input, advice and/or …

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关于急性儿科需要综合护理系统的最终警告

“急性”一词并非紧急情况的同义词，但它更好地描述了 2017-2018 年到急诊科就诊的 442 万儿童1（0-14 岁）的需求。这种“急诊”演示的巨大扩展发生得相对较快（2008-2009 年有 266 万例），并对传统的儿科服务提出了挑战。十年前，一个身体不适的孩子会向他们的全科医生 (GP) 提出建议，并在必要时转介给普通儿科医生进行“急性”治疗。现在，急诊护理的途径更加丰富，这反映了减轻对急诊科的需求以及在卫生政策中强调患者选择的尝试。十多年来，儿童（0-14 岁）的出勤率一直保持在所有紧急情况的 20% 左右1；然而，短期住院（少于 24 小时）正在成为大多数转诊的主要结果。2 虽然开辟了进入系统的新途径（电话服务、紧急护理中心等），但这导致了地区差异和父母的困惑。 3 我们仍然有旧的专业等级模式，这些模式限制了获得二级保健的机会，并且通常依赖于写信（尽管是电子方式），很少或根本不关注预防。这否定了早在 1920 年道森报告（图 1）就强调的一个重要的连续统一体，并且今天仍然对政策制定者提出挑战。图 1 Dawson 报告摘录，由 King's Fund 提供。造成这些连续性和全面性不足的原因是多方面的。当然，很可能是英国 2004 年的综合医疗服务合同，这改变了工作时间的规定，影响了对儿童的照顾，同时改变了社会对管理简单疾病的期望。然而，儿科医生在适应对专家意见、建议和/或……的不断增长的需求方面也很慢。