Multi-method evaluation of a paediatric ambulatory care unit (PACU): impact on families and staff

Abstract

Our study suggests that the PACU model is perceived to be an effective alternative to standard A&E services for the assessment and early management of acutely ill children and their families attending a hospital. It is highly valued by users, staff and referrers and enhances the patient journey. Lessons learnt include the need to enhance multi-disciplinary processes and clarify the role of this form of acute care provision in the wider healthcare system.

Interventions to reduce acute paediatric hospital admissions: a systematic review

“…Eighty-two papers were excluded (intervention not designed to reduce acute paediatric admissions n=48; non-systematic review, letter or editorial n=15; uncontrolled study n=10; no relevant outcome measures n=4; not a paediatric population n=3; duplicate publication n=1; full text unobtainable n=1; and results available only as a conference abstract with insufficient detail available to assess study design or risk of bias n=1) on perusal of the full text and of the bibliographies of included papers and reviews identified during the search, leaving seven studies for inclusion in the review (figure 1). 14–20 The updated search produced 391 additional results; the full text of four of these articles was retrieved for closer examination, but none were deemed to meet the inclusion criteria (intervention not designed to reduce paediatric admissions). Five papers were published in English, one was translated from Spanish17 and one from French 18…”

“…In four papers, the effects of the introduction of a short stay facility on admission rates are reported,14 18–20 while the remaining three papers are concerned with guideline-based admission policies in various conditions (diarrhoea,15 seizures,15 gastroenteritis16 and asthma) 17. We were unable to identify any eligible papers in which the effects of paediatric consultant decision on admission, telephone triage by paediatric consultant or next day emergency paediatric clinics on admission rates were studied.…”

“…We were unable to identify any eligible papers in which the effects of paediatric consultant decision on admission, telephone triage by paediatric consultant or next day emergency paediatric clinics on admission rates were studied. Six studies, using various non-randomised designs, report quantitative data15–20 and one reports qualitative data of the views of parents, staff and referrers 14. Characteristics of the included studies and study participants are shown in tables 1 and 2.…”

“…Characteristics of the included studies and study participants are shown in tables 1 and 2. Sample size ranged from 60 in the qualitative study14 to 8287 in a large, historically controlled trial of the use of a guideline for the management of acute gastroenteritis 16. Indicators of study quality are shown in table 2.…”

Preschool children who are frequent attenders in emergency departments: an observational study of associated demographics and clinical characteristics

“…Our unit has a four bed short-stay paediatric assessment unit (PAU) and 26 inpatient ward beds. The detailed functioning and evaluation of the PAU has been described previously 17. A retrospective observational study using routine operational data collected within the co-located UCC and the Accident and Emergency (A&E) department (collectively the ED) in a large District General Hospital.…”