Evaluation of appropriateness of paediatric admission.

Werneke, Ursula; MacFaul, R

doi:10.1136/adc.74.3.268

Cited by 12 publications

(7 citation statements)

References 16 publications

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“…In previous studies in other countries, the PAEP has been applied to mixtures of paediatric medical and surgical cases, emergency and elective admissions and to mixtures of secondary and tertiary care 4. The only other study which included a validation exercise based on expert panels related to children admitted to a tertiary care centre 6.…”

Section: Discussionmentioning

confidence: 99%

“…This was based on two considerations: (1) the need to review a mixture of appropriate and inappropriate admissions. Given an estimated 25% prevalence of inappropriate admissions,4 a random sample of 45 cases was needed with an error margin of ±12%, at a confidence level of 95% and (2) the validation exercise carried out in Canada limited the sample size to 50 cases in view of limited clinician time to participate in the exercise 6…”

Section: Methodsmentioning

confidence: 99%

“…Two versions for children, both called the paediatric appropriateness evaluation protocol (PAEP) were later derived from the adult tool 23 The PAEP has been used in several countries, although the methods of application and sampling strategies have been inconsistent making results difficult to compare 4…”

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confidence: 99%

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Validation of the paediatric appropriateness evaluation protocol in British practice

Werneke

Smith

et al. 1997

Archives of Disease in Childhood

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The reliability and validity of the North American paediatric appropriateness evaluation protocol (PAEP) for use in paediatric practice in Britain was tested. The protocol was applied to 418 case records of consecutive emergency admissions to three Yorkshire district general hospitals. The PAEP ratings were then compared with a clinical consensus opinion obtained from two expert panels. Altogether 32% of the admissions were rated inappropriate by the PAEP and 36% by the panels. Validity of the PAEP, as measured by agreement beyond chance with the expert panel rating, was only moderate with a of 0.29 (95% confidence interval 0.11 to 0.47). The PAEP has limited validity for evaluating British paediatric practice. Utilisation review instruments developed in diVering clinical cultures should be used with caution until shown to be valid for the practice setting under review. (Arch Dis Child 1997;77:294-298) Keywords: paediatric appropriateness evaluation protocol; hospitalisation; paediatric admissions Evaluation of appropriateness of an acute hospital admission with measurement tools based on standardised criteria is a relatively new concern in the UK. In North America, such utilisation review instruments have been developed and used since the 1970s, aiming to limit costs and increase eYciency of acute care. The instruments use so called explicit, objective criteria developed for this purpose. One of the widely applied tools is the appropriateness evaluation protocol for use in adult practice (AEP).1 The AEP criteria are based on the level of service provided and, to some extent, factors which identify severity of illness, independent of diagnoses. The protocols were designed for retrospective or concurrent application to case notes. Fulfilment of one of the relevant criteria would make that day of hospital care appropriate. The original criteria in the AEP were tailored to adult specialties. Two versions for children, both called the paediatric appropriateness evaluation protocol (PAEP) were later derived from the adult tool.2 3 The PAEP has been used in several countries, although the methods of application and sampling strategies have been inconsistent making results diYcult to compare. 4 Utilisation reviews are not designed as arbiters of individual patient care. However, results of reviews can influence patient care, service provision, and health policy. If they are unreliable or invalid their use may adversely aVect the quality of health care and unfairly penalise patients; for example admission may be discouraged though needed, or inpatient facilities erroneously reduced.5 On the other hand, evaluation of appropriateness of hospitalisation is a valuable method for monitoring services and informing planning or reconfiguration of services. It is essential, therefore, that before an audit tool is used, reliability and validity of the instruments are suYciently high. Reliability is a measure of reproducibility. Interobserver reliability measures the extent to which raters independently arrive at the sa...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Validation of the paediatric appropriateness evaluation protocol in British practice

Werneke

Smith

et al. 1997

Archives of Disease in Childhood

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“…Sensitivity, specificity, positive and negative predictive values of the developed tool was calculated. Experienced clinicians’ judgment was employed as the gold standard in these analyses ( 12 ). Finally, Kappa coefficient was also calculated to evaluate the agreement between the reviews using PAEP and the experienced clinicians’ judgment.…”

Section: Methodsmentioning

confidence: 99%

A Pediatric Appropriateness Evaluation Protocol for Iran Children Hospitals

Esmaili¹,

Seyedin²,

Faraji³

et al. 2014

Iran Red Crescent Med J

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Background:Applying utilization review programs is an appropriate solution to decrease the expenditure, and to increase the efficiency of healthcare systems.Objectives:This paper presents an instrument to measure the level of appropriate admissions and days of stay (DOS) in the pediatric public hospitals of Iran.Materials and Methods:The American version of the Pediatric Appropriateness Evaluation Protocol (PAEP) was modified and adjusted by our group of physicians. They carried out a retrospective study over 100 randomly selected patients. The reliability of the instrument was tested based on the consensus of reviewers using PAEP. In addition, the external validity of the instrument was studied by comparing the evaluations of the reviewers using PAEP and the individual judgments of three clinicians in two public teaching hospitals. Finally, reliability and validity were also calculated by the kappa statistic.Results:With respect to the inter-reliability testing, there was a high level of agreement between reviewers applying the instrument in the admissions criteria and days of stay. Overall agreement was > 77%; also specific inappropriate agreement and specific appropriate agreement were > 61%, and > 72%, respectively. Regarding the validity of the testing, the instrument had a sensitivity of > 0.75, specificity of > 0.67, as well as positive and negative predictive values of > 0.93, and > 0.55, respectively. The kappa statistic for the reviewers (using the instrument for admission and days of stay criteria) were substantial (k = 0.75.5 and 0.71). They were also substantial for clinicians (k = 0.73 and 0.66).Conclusions:These results showed that the modified PAEP is a reliable and valid instrument to study the appropriateness of admission and days of stay in Iran hospitals. As the developing countries, particularly, Middle East countries have the same status and culture, the result of this study (with minor changes) could be applied in these countries too.

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“…Concerns about the adverse effects of high bed occupancy 1 and increasing demand for limited healthcare resources raise questions about appropriate use of inpatient beds, 2 which may be assessed using the bed utilisation review. …”

Section: Introductionmentioning

confidence: 99%

Bed Utilisation in an Irish Regional Paediatric Unit – A Cross-Sectional Study Using the Paediatric Appropriateness Evaluation Protocol (PAEP)

ÓhAiseadha

Mannix

Saunders

et al. 2016

Int J Health Policy Manag

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Background: Increasing demand for limited healthcare resources raises questions about appropriate use of inpatient beds. In the first paediatric bed utilisation study at a regional university centre in Ireland, we conducted a cross-sectional study to audit the utilisation of inpatient beds at the Regional Paediatric Unit (RPU) in University Hospital Limerick (UHL), Limerick, Ireland and also examined hospital activity data, to make recommendations for optimal use of inpatient resources. Methods: We used a questionnaire based on the paediatric appropriateness evaluation protocol (PAEP), modified and validated for use in the United Kingdom, to prospectively gather data regarding reasons for admission and for ongoing care after 2 days, from case records for all inpatients during 11 days in February (winter) and 7 days in May–June (summer). We conducted bivariate and multivariate analysis to explore associations between failure to meet PAEP criteria and patient attributes including age, gender, admission outside of office hours, arrival by ambulance, and private health insurance. Inpatient bed occupancy and day ward activity were also scrutinised. Results: Mean bed occupancy was 84.1%. In all, 12/355 (3.4%, 95% CI: 1.5%–5.3%) of children failed to meet PAEP admission criteria, and 27/189 (14.3%, 95% CI: 9.3%–19.3%) who were still inpatients after 2 days failed to meet criteria for ongoing care. 35/355 (9.9%, 95% CI: 6.8%–13.0%) of admissions fulfilled only the PAEP criterion for intravenous medications or fluid replacement. A logistic regression model constructed by forward selection identified a significant association between failure to meet PAEP criteria for ongoing care 2 days after admission and admission during office hours (08.00–17.59) (P = .020), and a marginally significant association between this outcome and arrival by ambulance (P = .054). Conclusion: At a mean bed occupancy of 84.1%, an Irish RPU can achieve 96.6% appropriate admissions. Although almost all inpatients met PAEP criteria, improvements could be made regarding emergency access to social services, management of parental anxiety, and optimisation of access to community-based services. Potential ways to provide nasogastric or intravenous fluid therapy on an ambulatory basis, and outpatient antimicrobial therapy (OPAT) should be explored. Elective surgical admissions should adhere to day-of-surgery admissions (DOSA) policy.

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Evaluation of appropriateness of paediatric admission.

Cited by 12 publications

References 16 publications

Validation of the paediatric appropriateness evaluation protocol in British practice

Validation of the paediatric appropriateness evaluation protocol in British practice

A Pediatric Appropriateness Evaluation Protocol for Iran Children Hospitals

Bed Utilisation in an Irish Regional Paediatric Unit – A Cross-Sectional Study Using the Paediatric Appropriateness Evaluation Protocol (PAEP)

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