A study of admissions to paediatric beds

Abstract

Summary:The reasons for admission of children to paediatric beds and the appropriateness of those admissions were investigated by a retrospective study of admission notes by two paediatricians. Approximately 3% and 9% of the admissions according to assessor, were for purely social reasons and the remainder for predominantly medical reasons. There were a number of admissions for whom the assessors were unable to justify admission. Assessor 1 considered that 20% and assessor 2 15%, of those studied could have been managed without admission. Agreement over individual cases between assessors was poor but significant. The assessors agreed that admission was appropriate in 74% and inappropriate in 8% of cases. In the remaining 18 cases, the assessors did not agree on the need for admission. It is suggested that there is a need for local specialty specific admission policies to ensure cost-effective use of facilities.

Preventing paediatric admissions for respiratory disease: a qualitative analysis of the views of health care professionals

“…Therefore, it is not surprising that there is wide variation in estimates of the rate of inappropriate paediatric admissions in the UK. These range from 8% to 36% (Rajaratnam 1991; MacFaul et al. 1994, Werneke et al .…”

Evaluation of appropriateness of paediatric admission.

“…In 1991 Rajaratnam reported a study in Cardiff when two paediatric consultant raters using subjective (implicit) judgment on admission notes found 15% and 20% respectively of 620 admissions (which included elective ones) not to be required and 9% and 3% to be purely social. 23 However, the level of agreement between the raters was poor with a K coefficient of 0'37. He suggested the need for the assessment of appropriateness to be a routine part of audit of practice.…”