Understanding case mix across three paediatric services: could integration of primary and secondary general paediatrics alter walk-in emergency attendances?

Steele, Lloyd; Coote, Nicky; Klaber, Robert; Watson, Mando; Coren, M

doi:10.1136/archdischild-2017-314306

Cited by 12 publications

(16 citation statements)

References 13 publications

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“…This model of outreach by hospital paediatric specialists to primary care/hubs to build competence and confidence through case discussion and also offer individual consultations has been shown to yield a very positive impact on walk‐in emergency attendances 95 . Such an approach may reduce subsequent all‐cause emergency room attendances by half 96 …”

Section: Setting Standards and Improving Guidelines For Primary Carementioning

confidence: 99%

A worldwide charter for all children with asthma

Szefler

Fitzgerald

Adachi

et al. 2020

Pediatric Pulmonology

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Childhood asthma is a huge global health burden. The spectrum of disease, diagnosis, and management vary depending on where children live in the world and how their community can care for them. Global improvement in diagnosis and management has been unsatisfactory, despite ever more evidence‐based guidelines. Guidelines alone are insufficient and need supplementing by government support, changes in policy, access to diagnosis and effective therapy for all children, with research to improve implementation. We propose a worldwide charter for all children with asthma, a roadmap to better education and training which can be adapted for local use. It includes access to effective basic asthma medications. It is not about new expensive medications and biologics as much can be achieved without these. If implemented carefully, the overall cost of care is likely to fall and the global future health and life chance of children with asthma will greatly improve. The key to success will be community involvement together with the local and national development of asthma champions. We call on governments, institutions, and healthcare services to support its implementation.

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Section: Setting Standards and Improving Guidelines For Primary Carementioning

confidence: 99%

A worldwide charter for all children with asthma

Szefler

Fitzgerald

Adachi

et al. 2020

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

“…Our findings indicate that although SSPAUs may have been opened in response to increasing zero day admissions, SSPAUs may in some regions have been an factor associated with the increase in zero day admissions. The National Audit Office state that “at least one-fifth of admissions could be managed effectively in the community” [ 13 ], and recent publications have suggested that as many as 50% of emergency presentations could have been managed in the community [ 14 ] and care pathways for infants could reduce many admissions [ 15 ]. The existence of a steady rise in zero day admissions which then rises after an SSPAU opens and accelerates thereafter suggests that additional community-based interventions may offer a safe and convenient method to manage at many of acute childhood illnesses currently referred to hospital.…”

Section: Discussionmentioning

confidence: 99%

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

Turner

Raja

2021

BMC Health Serv Res

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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.

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“…Our ndings indicate that although SSPAUs may have been opened in response to increasing zero day admissions, SSPAUs may in some regions have been an factor associated with the increase in zero day admissions. The National Audit O ce state that "at least one-fth of admissions could be managed effectively in the community" 13 , and recent publications have suggested that as many as 50% of emergency presentations could have been managed in the community 14 and care pathways for infants could reduce many admissions. 15 The existence of a steady rise in zero day admissions which then rises after an SSPAU opens and accelerates thereafter suggests that additional community-based interventions may offer a safe and convenient method to manage at many of acute childhood illnesses currently referred to hospital.…”

Section: Discussionmentioning

confidence: 99%

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

Turner

Raja

2020

Preprint

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Background. Rising acute paediatric hospital admissions in Scotland are explained by rising numbers of admissions lasting less than 24 hours (zero day admissions). 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 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. The rise in zero day admissions was greater in health boards with no SSPAU compared to those with an SSPAU. 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 may increase in the proportion of zero day admissions, but in some settings may reduce this proportion. 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.

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Understanding case mix across three paediatric services: could integration of primary and secondary general paediatrics alter walk-in emergency attendances?

Abstract: One in two attendances to acute paediatric services could have been managed in the community. Integration of paediatric services could help address parental reasons for attending acute services, as well as facilitating the community management of chronic conditions.

Cited by 12 publications

References 13 publications

A worldwide charter for all children with asthma

A worldwide charter for all children with asthma

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

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

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