Interventions to reduce acute paediatric hospital admissions: a systematic review

Abstract

BackgroundAdmission rates are rising despite no change to burden of illness, and interventions to reduce unscheduled admission to hospital safely may be justified.ObjectiveTo systematically examine admission prevention strategies and report long-term follow-up of admission prevention initiatives.Data sourcesMEDLINE, 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 criteriaRandomised controlled trials and before-and-after studies.ParticipantsIndividuals aged <18 years.Study appraisal and synthesis methodsStudies 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.ResultsTwenty-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 implicationsThere is little robust evidence to support interventions aimed at preventing paediatric admissions and further research is needed.

Short stay hospital admissions for an acutely unwell child: A qualitative study of outcomes that matter to parents and professionals

“…The challenge is to identify what an effective change looks like. A recent systematic review of interventions to reduce unscheduled admissions of children to hospital concluded there is lack of robust evidence to support their effectiveness and, interestingly, few included interventions focused on the prehospital pathway [31]. Conversely, interventions targeted at the pre-hospital pathway showed potential to reduce ED attendance largely amongst the adult population, whilst equally lacking sufficient quality evidence to make conclusions around their effectiveness [32].…”

Insights from and limitations of data linkage studies: analysis of short-stay urgent admission referral source from routinely collected Scottish data

“…FLAMINGO’s whole body of work will contribute to a debate around targeted or universal interventions to address the rising SSA problem, and inform the design of future interventions for safe urgent care from a parent and health professional perspective. Evidence for effective interventions to avoid SSAs is poor,7 and pragmatic randomised controlled trials are required to investigate whether alternative care pathways can safely reduce SSA.…”

“…(4,5) Managing acutely unwell children in the community, instead of a hospital ward, and enabling them to stay at home has been suggested as an alternative to admission (6), but it is not clear which interventions delivered where and by whom might safely reduce urgent admissions. (7) Interventions could be delivered at the initial point of contact between the patient and healthcare services and/or between referral service and inpatient facility (i.e. hospital).…”

“…Short-stay admissions (SSAs), defined here as a hospitalisation where admission and discharge occurred on the same day, explain most of the rise in urgent admissions 4 5. Managing acutely unwell children in the community, instead of a hospital ward, and enabling them to stay at home have been suggested as an alternative to admission,6 but it is not clear which interventions delivered where and by whom might safely reduce urgent admissions 7…”

“…for safe urgent care from a parent and health professional perspective. The evidence for effective interventions to avoid SSAs is poor(7) and pragmatic randomised controlled trials are required to investigate whether alternative care pathways can safely reduce SSA. ISD SG.…”