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Interventions to reduce acute paediatric hospital admissions: A systematic review
  1. A Martin1,
  2. J Thompson Coon2,
  3. AD Abdul-Rahman2,
  4. K Boddy2,
  5. R Whear2,
  6. A Collinson3,
  7. K Stein2,
  8. S Logan2
  1. 1Department of Paediatrics, Royal Devon and Exeter Hospital, Exeter, UK
  2. 2PenCLAHRC, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK
  3. 3Department of Child Health, Royal Cornwall Hospitals NHS Trust, Truro, UK

Abstract

Aim To estimate the effectiveness of interventions designed to reduce the rate of acute paediatric hospital admissions.

Methods Study design: Systematic review.

Data sources Medline, Embase, PsycINFO, The Cochrane Library, Science Citation Index Expanded from inception to August 2011; hand searches of the reference lists of included papers.

Inclusion criteria Studies assessing the effect of any of 5 interventions designed to reduce acute paediatric admissions, which compared admission and/or readmission rates, patient or carer experience or cost against contemporaneous or historical control data. Interventions included were a) paediatric consultant compared to junior doctor decision on admission; b) telephone triage by paediatric consultant; c) “ambulatory care/short stay units”; d) algorithm guided management of acute presentations; e) next day emergency paediatric clinics.

Review methods Articles were screened for inclusion ­independently by two reviewers. Data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third.

Results Seven papers were included. 3 studies examined the use of algorithms and none reported a reduction in admission rates. 4 studies reported on the effects of “short stay” units; 3 before-after studies reported a reduction in admissions and 1 largely qualitative study suggested that both clinicians and families were generally supportive. We failed to identify any studies examining the effects of admission decision-making by paediatric consultants, consultant telephone triage or the establishment of next day clinics. All included studies had major methodological weaknesses hindering interpretation.

Conclusion The rate of paediatric admissions continues to rise although duration of admissions has fallen. A range of interventions have been recommended to address the rising admission rate but this review suggests that the evidence base for these recommendations is slim. Most studies are methodologically limited and for some proposed interventions we were unable to find any published evidence. Future service change should be implemented in the context of rigorous evaluations, aiming to produce high quality evidence to inform further improvements.

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