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Interventions to reduce acute paediatric hospital admissions: a systematic review
  1. Smita Dick1,
  2. Clare MacRae2,
  3. Claire McFaul1,
  4. Usman Rasul1,
  5. Philip Wilson3,
  6. Stephen W Turner1
  1. 1Department of Child Health, University of Aberdeen, Aberdeen, UK
  2. 2Usher institute, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
  3. 3Institute of Health and Wellbeing, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Stephen W Turner, Department of Child Health, University of Aberdeen, Aberdeen, AB24 3FX, UK; s.w.turner{at}abdn.ac.uk

Abstract

Background Admission rates are rising despite no change to burden of illness, and interventions to reduce unscheduled admission to hospital safely may be justified.

Objective To systematically examine admission prevention strategies and report long-term follow-up of admission prevention initiatives.

Data sources MEDLINE, Embase, OVID SP, PsychINFO, Science Citation Index Expanded/ISI Web of Science, The Cochrane Library from inception to time of writing. Reference lists were hand searched.

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

Participants Individuals aged <18 years.

Study appraisal and synthesis methods Studies were independently screened by two reviewers with final screening by a third. Data extraction and the Critical Appraisals Skills Programme checklist completion (for risk of bias assessment) were performed by one reviewer and checked by a second.

Results Twenty-eight studies were included of whom 24 were before-and-after studies and 4 were studies comparing outcomes between non-randomised groups. Interventions included referral pathways, staff reconfiguration, new healthcare facilities and telemedicine. The strongest evidence for admission prevention was seen in asthma-specific referral pathways (n=6) showing 34% (95% CI 28 to 39) reduction, but with evidence of publication bias. Other pathways showed inconsistent results or were insufficient for wider interpretation. Staffing reconfiguration showed reduced admissions in two studies, and shorter length of stay in one. Short stay admission units reduced admissions in three studies.

Conclusions and implications There is little robust evidence to support interventions aimed at preventing paediatric admissions and further research is needed.

  • health services research
  • epidemiology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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Footnotes

  • Contributors SWT conceived the study. All authors contributed towards the design of the review, were involved in interpretation of the data and critically revised the manuscript for all important intellectual content and approved the final version. In addition, SD, CMF and CMR screened the titles, abstracts and full texts. SWT and PW resolved any conflicts around the selection process. SD, CMF and CMR carried out the data extraction, quality assessment and also screened the bibliographies of the identified papers during the process. SWT, UR and SD carried out the follow-up of the UK-based admission prevention initiatives. SWT and SD wrote the first draft of the manuscript.

  • 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.

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