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Interventions in primary and community care to reduce urgent paediatric hospital admissions: systematic review
  1. Smita Dick1,
  2. Clare MacRae2,
  3. Claire McFaul1,
  4. Philip Wilson3,
  5. Stephen W Turner1
  1. 1 Department of Child Health, University of Aberdeen, Aberdeen, UK
  2. 2 Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  3. 3 Institute of Health and Wellbeing, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Professor Stephen W Turner, Department of Child Health, University of Aberdeen, Aberdeen, AB25 2ZG, UK; s.w.turner{at}


Background There has been a rise in urgent paediatric hospital admissions and interventions to address this are required.

Objective To systemically review the literature describing community (or non-hospital)-based interventions designed to reduce emergency department (ED) visits or urgent hospital admissions.

Data sources MEDLINE, Embase, OVIS SP, PsycINFO, Science Citation Index Expanded/ISI Web of Science (1981–present), the Cochrane Library database and the Database of Abstracts of Reviews of Effectiveness.

Study eligibility criteria Randomised controlled trials (RCTs) and before-and-after studies.

Participants Individuals aged <16 years.

Study appraisal and synthesis methods Papers were independently reviewed by two researchers. Data extraction and the Critical Appraisals Skills Programme checklist was completed (for risk of bias assessment).

Results Seven studies were identified. Three studies were RCTs, three were a comparison between non-randomised groups and one was a before-and-after study. Interventions were reconfiguration of staff roles (two papers), telemedicine (three papers), pathways of urgent care (one paper) and point-of-care testing (one paper). Reconfiguration of staff roles resulted in reduction in ED visits in one study (with a commensurate increase in general practitioner visits) but increased hospital admissions from ED in a second. Telemedicine was associated with a reduction in children’s admissions in one study and reduced ED admissions in two further studies. Interventions with pathways of care and point-of-care testing did not impact either ED visits or urgent admissions.

Conclusions and implications New out-of-hospital models of urgent care for children need to be introduced and evaluated without delay.

PROSPERO registration number CRD42021274374.

  • epidemiology
  • health services research

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors SWT conceived the study. SD designed the search strategy and carried out the literature searches. SD, CMR and CMcF screened the titles, abstracts and full texts. SWT and PW resolved any conflicts around the selection process. SD, CMR and CMcF carried out the data extraction and quality assessment. SWT and SD wrote the first draft and all authors were involved in the interpretation of data and provided valuable contribution towards reviewing, editing and completion of the final draft. All authors had access to all the data in the study and the responsibility for the decision to submit for publication. ST is guarantor for the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.