Multi-Stakeholder Informed Guidelines for Direct Admission of Children to Hospital

Leyenaar, JoAnna K.; Shevenell, Megan; Rizzo, Paul A.; Hill, Vanessa; Lindenauer, Peter K.

doi:10.1016/j.jpeds.2018.03.007

Cited by 12 publications

(15 citation statements)

References 17 publications

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“…The system factors summarized in this model, including clinic and ED factors, were described by parents of hospitalized children as influential to their decisions about when and where they seek care for their child's acute illnesses [8]. The processes of care factors are derived from deliberative discussions with stakeholders in the hospital admission process [18].…”

Section: Theoretical Frameworkmentioning

confidence: 99%

“…We will limit our analysis to children < 18 years of age admitted with the following common medical reasons for hospitalization: gastroenteritis, dehydration, SSTI, UTI/pyelonephritis, pneumonia, influenza, and viral infection not otherwise specified. These diagnoses comprise approximately 25% of all unscheduled pediatric admissions nationally and represent conditions that have been identified as appropriate for direct admission but not currently accepted for direct admission at the participating hospitals [1,18]. Children with planned admissions (e.g., chemotherapy), those admitted to the intensive care unit or other subspecialty services, and those transferred from other hospitals will be excluded.…”

Section: Comparators and Study Eligibilitymentioning

confidence: 99%

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Comparative effectiveness of direct admission and admission through emergency departments for children: a randomized stepped wedge study protocol

Leyenaar

McDaniel

Acquilano

et al. 2020

Trials

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Background Approximately 2 million children are hospitalized each year in the United States, with more than three-quarters of non-elective hospitalizations admitted through emergency departments (EDs). Direct admission, defined as admission to hospital without first receiving care in the hospital’s ED, may offer benefits for patients and healthcare systems in quality, timeliness, and experience of care. While ED utilization patterns are well studied, there is a paucity of research comparing the effectiveness of direct and ED admissions. The overall aim of this project is to compare the effectiveness of a standardized direct admission approach to admission beginning in the ED for hospitalized children. Methods/design We will conduct a stepped wedge cluster randomized controlled trial at 3 structurally and geographically diverse hospitals. A total of 70 primary and urgent care practice sites in the hospitals’ catchment areas will be randomized to a time point when they will begin participation in the multi-stakeholder informed direct admission program. This crossover will be unidirectional and occur at 4 time points, 6 months apart, over a 24-month implementation period. Our primary outcome will be the timeliness of clinical care provision. Secondary outcomes include (i) parent-reported experience of care, (ii) unanticipated transfer to the intensive care unit within 6 h of hospital admission, and (iii) rapid response calls within 6 h of hospital admission. We anticipate that 190 children and adolescents will be directly admitted, with 1506 admitted through EDs. Analyses will compare the effectiveness of direct admission to admission through the ED and will evaluate the causal effect of implementing a direct admission program using linear regression with random effects for referring practice clusters and time period fixed effects. We will further examine the heterogeneity of treatment effects based on hypotheses specified a priori. In addition, we will conduct a mixed-methods process evaluation to assess reach, effectiveness, adoption, implementation, and maintenance of our direct admission intervention. Discussion Our study represents the first randomized controlled trial to compare the effectiveness of direct admission to admission through the ED for pediatric patients. Our scientific approach, pairing a stepped wedge design with a multi-level assessment of barriers to and facilitators of implementation, will generate valuable data about how positive findings can be reproduced across other healthcare systems. Trial registration ClinicalTrials.gov NCT04192799. Registered on December 10, 2019).

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Section: Theoretical Frameworkmentioning

confidence: 99%

Section: Comparators and Study Eligibilitymentioning

confidence: 99%

Comparative effectiveness of direct admission and admission through emergency departments for children: a randomized stepped wedge study protocol

Leyenaar

McDaniel

Acquilano

et al. 2020

Trials

Self Cite

View full text Add to dashboard Cite

show abstract

“…8 The processes of care factors are derived from deliberative discussions with stakeholders in the hospital admission process. 18…”

Section: Theoretical Frameworkmentioning

confidence: 99%

“…visits, a PHM service that provides care to 6000 children each year, and a pediatric infectious 1,18 Children with planned admissions (e.g. chemotherapy), those admitted to the intensive care unit or other subspecialty services, and those transferred from other hospitals will be excluded.…”

Section: Settingmentioning

confidence: 99%

“…The direct admission intervention will involve five core elements, endorsed by a national multistakeholder panel: 18 During the pre-implementation period, each DALT will meet to discuss intervention elements within the context of local system, organization, provider, and patient characteristics. These discussions will be supported by review of local administrative data and pilot data of study outcomes, with tailoring of educational materials and tools as appropriate.…”

Section: Intervention Core Elementsmentioning

confidence: 99%

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Comparative Effectiveness of Direct Admission & Admission through Emergency Departments for Children: A Randomized Stepped Wedge Study Protocol

Leyenaar

McDaniel

Acquilano

et al. 2020

Preprint

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Background: Approximately 2 million children are hospitalized each year in the United States, with more than three-quarters of non-elective hospitalizations admitted through emergency departments (EDs). Direct admission, defined as admission to hospital without first receiving care in the hospital’s ED, may offer benefits for patients and healthcare systems in quality, timeliness, and experience of care. While ED utilization patterns are well studied, there is a paucity of research comparing the effectiveness of direct and ED admissions. The overall aim of this project is to compare the effectiveness of a standardized direct admission approach to admission beginning in the ED for hospitalized children.Methods/Design: We will conduct a stepped wedge cluster randomized controlled trial at 3 structurally and geographically diverse hospitals. A total of 70 primary and urgent care practice sites in the hospitals’ catchment areas will be randomized to a time point when they will begin participation in the multi-stakeholder informed direct admission program. This crossover will be unidirectional and occur at 4 time points, six months apart, over a 24-month implementation period. Our primary outcome will be the timeliness of clinical care provision. Secondary outcomes include: (i) parent-reported experience of care; (ii) unanticipated transfer to the intensive care unit within 6 hours of hospital admission; and (iii) rapid response calls within 6 hours of hospital admission. We anticipate that 190 children and adolescents will be directly admitted, with 1506 admitted through EDs. Analyses will compare the effectiveness of direct admission to admission through the ED, and will evaluate the causal effect of implementing a direct admission program using linear regression with random effects for referring practice clusters and time period fixed effects. We will further examine heterogeneity of treatment effects based on hypotheses specified a priori. In addition, we will conduct a mixed-methods process evaluation to assess reach, effectiveness, adoption, implementation and maintenance of our direct admission intervention.Discussion: Our study represents the first randomized controlled trial to compare the effectiveness of direct admission to admission through the ED for pediatric patients. Our scientific approach, pairing a stepped-wedge design with a multi-level assessment of barriers to and facilitators of implementation, will generate valuable data about how positive findings can be reproduced across other healthcare systems.Trial registration: This trial is registered in ClinicalTrials.gov (NCT04192799, registered December 10, 2019, https://clinicaltrials.gov/ct2/show/NCT04192799)

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Multistakeholder Perspectives on Interventions to Support Youth During Mental Health Boarding

Brady¹,

Ivany²,

Nagarajan³

et al. 2023

The Journal of Pediatrics

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Multi-Stakeholder Informed Guidelines for Direct Admission of Children to Hospital

Abstract: These direct admission guidelines can be adapted by hospitals and health systems to inform hospital admission policies and protocols. Multistakeholder engagement in evaluation of hospital admission processes may improve transitions of care and health system integration.

Cited by 12 publications

References 17 publications

Comparative effectiveness of direct admission and admission through emergency departments for children: a randomized stepped wedge study protocol

Comparative effectiveness of direct admission and admission through emergency departments for children: a randomized stepped wedge study protocol

Comparative Effectiveness of Direct Admission & Admission through Emergency Departments for Children: A Randomized Stepped Wedge Study Protocol

Multistakeholder Perspectives on Interventions to Support Youth During Mental Health Boarding

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Multi-Stakeholder Informed Guidelines for Direct Admission of Children to Hospital

Abstract: These direct admission guidelines can be adapted by hospitals and health systems to inform hospital admission policies and protocols. Multistakeholder engagement in evaluation of hospital admission processes may improve transitions of care and health system integration.

Cited by 12 publications

References 17 publications

Comparative effectiveness of direct admission and admission through emergency departments for children: a randomized stepped wedge study protocol

Comparative effectiveness of direct admission and admission through emergency departments for children: a randomized stepped wedge study protocol

Comparative Effectiveness of Direct Admission &amp; Admission through Emergency Departments for Children: A Randomized Stepped Wedge Study Protocol

Multistakeholder Perspectives on Interventions to Support Youth During Mental Health Boarding

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Comparative Effectiveness of Direct Admission & Admission through Emergency Departments for Children: A Randomized Stepped Wedge Study Protocol