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Does increased duration of consultant presence affect length of hospital stay for unplanned admissions in acute paediatrics?: an observational before-and-after analysis using administrative healthcare data
  1. Daniel Cromb1,
  2. Chris Carter2,
  3. Claire Lemer1,
  4. C Ronny Cheung1
  1. 1Department of General Paediatrics, Evelina London Children's Hospital, St Thomas’ Hospital, London, UK
  2. 2Clinical Analytics Department, Evelina London Children's Hospital, St Thomas’ Hospital, London, UK
  1. Correspondence to Dr C Ronny Cheung, Department of General Paediatrics, Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK; ronny.cheung{at}gstt.nhs.uk

Abstract

Objectives This study aims to review whether implementation of increased duration of consultant presence is associated with reduction in length of hospital stay (LoS) in children with an unplanned admission to hospital.

Method (design/setting/participants/interventions/outcome measures) An observational before-and-after study of all unplanned general paediatric admissions to a UK hospital between 1 September 2012 and 31 August 2015, comparing LoS and readmission rates before and after implementation of a policy mandating consultant review within 12 hours of unplanned hospital admission.

Results 5367 inpatient admissions were analysed: 3386 prior to implementation of the policy and 1981 afterwards. There was no significant difference in median LoS between the two groups or in readmission rates at 24 hours, 48 hours or 7 days. However, among children who stayed in hospital for under 24 hours, and those who were discharged with a diagnosis of acute gastroenteritis, consultant review within 12 hours of admission was associated with a shorter LoS—respectively, 16 hours 23 min versus 15 hours 45 min (p=0.01) and 28 hours 46 min versus 19 hours 41 m (p<0.01).

Conclusions Increased duration of consultant presence was not associated with significant impact on LoS, other than in admissions of brief duration and in gastroenteritis, where diagnosis is based on clinical judgement in the absence of objective diagnostic thresholds. Future studies should focus on whether these results are generalisable across other settings, and other measures of cost-effectiveness of early consultant review, given the major implications on resource and workforce planning of such policies.

  • Health services research
  • Health Service
  • General Paediatrics

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Footnotes

  • Contributors DC designed the study, planned and performed the data analyses, wrote and revised the manuscript. CC extracted and analysed the data and revised the manuscript. CL revised the manuscript. CRC initiated and designed the study, supervised data collection and analyses, wrote and revised the manuscript. He is the guarantor. The guarantor affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Competing interests None declared.

  • Ethics approval Ethical approval was not required for this study: this study was performed on an anonymised data set, and no identifiable patient data were collected, kept or used by the authors.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The full data set and statistical code are available from the corresponding author on request. The presented data are anonymised and risk of identification is low.

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