The association between opening a short stay paediatric assessment unit and trends in short stay hospital admissions

Abstract

Background Many inpatient facilities in Scotland have opened short stay paediatric assessment units (SSPAU) which are clinical areas separate from the usual inpatient ward area and these are where most short stay (also called zero day) admissions are accommodated. Here we describe the effect of opening short stay paediatric assessment units (SSPAU) on the proportion of zero day admissions relative to all emergency admissions. Methods Details of all emergency medical paediatric admissions to Scottish hospitals between 2000 and 2013 were obtained, including the number of zero day admissions per month and health board (i.e. geographic region). The month and year that an SSPAU opened in each health board was provided by local clinicians. Results SSPAUs opened in 7 health boards, between 2004 and 2012. Health boards with an SSPAU had a slower rise in zero day admissions compared to those without SSPAU (0.6% per month [95% CI 0.04, 0.09]. Across all 7 health boards, opening an SSPAU was associated with a 13% [95% CI 10, 15] increase in the proportion of zero day admissions. When considered individually, zero day admissions rose in four health boards after their SSPAU opened, were unchanged in one and fell in two health boards. Independent of SSPAUs opening, there was an increase in the proportion of all admissions which were zero day admissions (0.1% per month), and this accelerated after SSPAUs opened. Conclusion Opening an SSPAU has heterogeneous outcomes on the proportion of zero day admissions in different settings. Zero day admissions could be reduced in some health boards by understanding differences in clinical referral pathways between health boards with contrasting trends in zero day admissions after their SSPAU opens.

A comparison of statistical methods for modeling count data with an application to hospital length of stay

“…Hospital LOS data are rarely zero-inflated. However, studies have reported rising in zero days hospital admissions (i.e., hospital stays of less than 24 h) in pediatric patients and in admissions with URTI/viral infection, gastroenteritis, croup, bronchiolitis, asthma, tonsillitis, non-specific abdominal pain, constipation, febrile convulsion, and rash diagnoses [ 69 , 72 , 73 ]. This may reflect a combination of factors including availability of more rapid assessment and effective treatment of acute presentation and declining hospital expertise and resources [ 72 ].…”

Interventions in primary and community care to reduce urgent paediatric hospital admissions: systematic review

“…Interventions in the hospital setting may only reduce admissions if there is also a change in provision in the community surrounding the hospital. For example, when a short-stay paediatric assessment unit is opened in a hospital, admissions may fall but also may rise21 and this divergence of results may reflect different referral pathways into hospital from the community between different centres. A second example is that after a paediatric ward is partly or fully closed, admissions to the neighbouring hospital, where inpatient services are maintained, depend on what contingencies are placed in the community where closure takes place 22.…”

“…We included one the scheduled context,(9) since this provided training to health care professionals to support them in providing clinical care for children urgently unwell with asthma, and we believed was within our inclusion criteria.In our work for the present and our earlier review(5) we have not identified interventions at the interface between community and hospital, and this context may have an impact on safely reducing admissions since interventions in the hospital setting may only reduce admissions in the context of provision in the community surrounding the hospital. For example when a short stay paediatric assessment unit (SSPAU) is opened in a hospital, admissions may fall but also may rise(21) and this divergence of results may reflect different referral pathways into hospital from the community between different centres. A second example is that after a paediatric ward is partly or fully closed, admissions to the neighbouring hospital, where inpatient services are maintained, depend on what contingencies are placed in the community where closure takes place (22).…”