Interventions to reduce acute paediatric hospital admissions: a systematic review

Abstract

There is little published evidence upon which to base an optimal strategy for reducing paediatric admission rates. The evidence that does exist is subject to substantial bias. There is a pressing need for high quality, well conducted research to enable informed service change.

The impact of a change in referral pathway on a paediatric short-stay ward in Cape Town, South Africa

“…The benefit of short-stay wards is that they may reduce the rate of admission to inpatient units, with reduced length of stay in hospital for patients. [19,20] Our study, however, reports higher admission rates to inpatient wards from the short-stay ward compared with other units, with our admission rate of 34% (2011) and 39% (2012) higher than the 15 -25% reported in other studies. [15,18,21] Similar to other units, respiratory illnesses, gastroenteritis and infectious diseases were the most common diagnoses.…”

Increase in emergency admissions to hospital for children aged under 15 in England, 1999-2010: national database analysis

“…An increase in the perceived risk of legal claims may be important in encouraging junior doctors to be risk averse 20. New models of acute paediatric care, such as short-stay units and emergency outpatient consultations, are emerging21–23 and these may have both lowered the threshold for admission and (by increasing the efficiency with which acute problems such as asthma and dehydration are managed) have decreased the length of stay, thereby increasing the number of very-short-term admissions.…”

SABRE: a multicentre randomised control trial of nebulised hypertonic saline in infants hospitalised with acute bronchiolitis

“…The mean duration for admission in the UK is around 3.3 days, 17 compared with a median of 1.5 days for all acute paediatric admissions. 18 Since the introduction of oxygen therapy, antiviral agents, oral and inhaled steroids and a variety of bronchodilators have neither decreased lengths of inpatient stay nor impacted on the course of the acute illness, 1–4 7–10 while an effective vaccine still appears someway off. 19 …”