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

Abstract

Background Numbers of urgent short stay admissions (SSAs) of children to UK hospitals are rising rapidly. This paper reports on experiences of SSAs from the perspective of parents accessing urgent care for their acutely unwell child and of health professionals referring, caring for, or admitting children. Methods A qualitative interview study was conducted by a multi-disciplinary team with patient and public involvement (PPI) to explore contextual factors relating to SSAs and better understand pre-hospital urgent care pathways. Purposive sampling of Health Board areas in Scotland, health professionals with experience of paediatric urgent care pathways and parents with experience of a SSA for their acutely unwell child was undertaken to ensure maximal variation in characteristics such as deprivation, urban-rural and hospital structure. Interviews took place between Dec 2019 and Mar 2021 and thematic framework analysis was applied. Results Twenty-one parents and forty-eight health professionals were interviewed. In the context of an urgent SSA, the themes were centred around shared outcomes of care that matter. The main outcome which was common to both parents and health professionals was the importance of preserving the child’s safety. Additional shared outcomes by parents and health professionals were a desire to reduce worries and uncertainty about the illness trajectory, and provide reassurance with sufficient time, space and personnel to undertake a period of skilled observation to assess and manage the acutely unwell child. Parents wanted easy access to urgent care and, preferably, with input from paediatric-trained staff. Healthcare professionals considered that it was important to reduce the number of children admitted to hospital where safe and appropriate to do so. Conclusions The shared outcomes of care between parents and health professionals emphasises the potential merit of adopting a partnership approach in identifying, developing and testing interventions to improve the acceptability, safety, efficiency, and cost-effectiveness of urgent care pathways between home and hospital.

Emergency department overcrowding: causes and solutions

“…We also found that people prefer to use EDs over GP clinics because GPs have limited interventions and equipment available. In line with this study, Butun et al [5] and Malcolm et al [26] found that patients had insufficient knowledge about GP clinics and how to use them appropriately. Improving primary health care services such as improving the physical conditions of buildings, medical equipment, and qualified staff should be considered as solutions for reducing nonurgent ED visits and, therefore, improving the quality of care.…”

Identifying and prioritising future interventions with stakeholders to improve paediatric urgent care pathways in Scotland, UK: a mixed-methods study

“…For quantitative purposes, SSA can be defined as a patient being admitted and discharged on the same calendar day 1 2. For qualitative sampling, since some parents cannot recall the precise time of admission and discharge, SSA can be defined as where parents’ recall their child being admitted and discharged within 24 hours 3. The rate of hospital medical admissions for children with acute illness in Scotland rose by 49% between 2000 and 2013, with SSAs rising by 186% from 8.6 to 24.6/1000 children per annum 2.…”

Commentary: ‘And then there was silence’: shaping practice through the experience of parents’ emotions

“…And from those questions, about who should be listened to and the context of that evidence in making decisions about children and their care. "Nurses are often described as closest to their patients, due to the intimate nature of their practice" (Levy, 2023: 15).Given that the majority of admissions to children's units is approximately 24 hours (Malcolm et al, 2022), under these circumstances, the people closest to the children will almost certainly be the parents, which will most probably be the mother/prime carer. However, care needs to be taken with issues of 'ownership' of the child being dealt with subtlety and respect for both the rights of the parents and the child (Shields et al, 2003).…”

“…Given that the majority of admissions to children's units is approximately 24 hours (Malcolm et al, 2022), under these circumstances, the people closest to the children will almost certainly be the parents, which will most probably be the mother/prime carer. However, care needs to be taken with issues of 'ownership' of the child being dealt with subtlety and respect for both the rights of the parents and the child (Shields et al, 2003).…”

“…The expertise of the children’s nurse at this stage is in their ongoing experience of caring for many children who have had this same diagnosis over potentially many years. It is this expertise that the parents are seeking for their child, even though the nurse is not closest to their patients, the parents are (Malcolm et al, 2022). Of course, this logic is akin to Martha’s rule (RCPCH, 2023).…”