Table 3.

Quotes from receiving clinicians relating to some of the factors which they believe may influence parents and referring clinician’s decision to refer a child to hospital with an acute medical condition.

Factors	Quotes
Parent expectations	“…there is a lot of information about illnesses that are potentially lethal and parents tend to panic with the very small things…” (Doctor E)
	“I think parents nowadays are probably a wee bit more demanding than they used to be, so I don’t know whether they trust their GPs maybe as much as people did in the past and so want a second opinion quite a lot of the time.” (Doctor B)
	“I think most of the time it’s either a parent not coping with their child being unwell even if they are well enough to be at home or it’s over caution on our part.” (Doctor C)
Experience of referring clinicians	“The fact that quite often GPs get to become GPs without actually doing any Paediatrics is a bit of an issue.” (Doctor C)
	“…they have difficulty recognising quite straight forward childhood problems…” (Doctor D)
	All of the receiving clinicians suggested that more paediatric exposure and training for GPs may help reduce the numbers of acute medical paediatric emergency admissions.
Views on whether a short period of observation is considered to be appropriate	“I think if they come in and then are assessed and sent home then that is obviously an admission that didn’t need to come in and see us.” (Doctor B)
	“…here in PAU we have the opportunity for a short period of observation which often allows us to be more confident about sending a child home…” and this doctor also mentioned that “…observation is not harmful…” (Doctor E)
	“…I think it is good for the benefit of the family…” (Doctor G)
	“…we do send lots home very quickly so therefore you could argue that they didn’t need to be admitted but I think part of the just being seen, being assessed and reassured is part of the process.” (Doctor D)