Table 4 Narrow eligibility criteria

Because of the narrow eligibility criteria, and the need to identify eligible patients by a specific diagnosis associated with the presenting complaint, often it was difficult to identify sufficient numbers of eligible patients, particularly for recruitment method 2 during the research visit (see Appendix), for example if the diagnosis was made at the end of the patients’ visit.

Some emergency departments did not see children or streamed them to a separate paediatric assessment unit at the hospital, rather than the GP service in the emergency department. Furthermore, public health education has encouraged patients with chest pain to phone an ambulance. For those who do self-present in the emergency department, many departments had strict guidelines which meant chest pain patients were automatically seen by an emergency department doctor.

Thus, local protocols made it difficult to identify children who had been seen in the emergency department and patients with chest pain who had been seen by a general practitioner.

There were not enough patients coming through the department with marker conditions during the time we were there. I couldn’t find one patient on Saturday afternoon.

- (Field notes - hospital 4)

We did not find any [patients] who had seen a GP with chest pain as they usually go to ED doctor.

- (Field notes - hospital 9)

While all research needs appropriate eligibility criteria to answer its research question(s), consideration should be given to how eligible patients will be identified.

Using broader initial eligibility criteria (for example, just searching by presenting complaint rather than presenting complaint and diagnosis) may result in more patients being identified.