Parental and professional perception of need for emergency admission to hospital: prospective questionnaire based study

Abstract

Aim-To compare views of parents, consultants, and general practitioners on severity of acute illness and need for admission, and to explore views on alternative services. Method-Prospective questionnaire based study of 887 consecutive emergency paediatric admissions over two separate three week periods in summer and winter of five Yorkshire hospitals, combined with a further questionnaire on a subsample. Outcome measures-Parental scores of need for admission and parent and consultant illness severity scores out of 10. Consultant judgment of need for admission. Alternatives to admission considered by consultants and, for a subsample, by parents and family GP. Results-Ninety nine per cent of parents thought admission was needed. Parents scored need for admission more highly than severity of illness with no association observed between severity and presenting problem or diagnosis. High parental need score was associated with a fit, past illness, and length of stay. Consultant illness severity scores were skewed to the lower range. Consultants considered admission necessary in 71%, especially for children aged over 1 year, presentation with breathing diYculty or fit, and after a longer stay. More admissions in the evening were considered unnecessary as were admissions after longer preadmission illness, gastroenteritis, or upper respiratory tract infection. Of a subsample of parents, 81% preferred admission during the acute stage of illness even if home nursing had been available. Similar responses were obtained from GPs. Alternative services could have avoided admission for 19% of children, saving 15.6% of bed days used. Conclusions-Medical professionals and parents diVer in their views about admission for acute illnesses. More information is needed on children not admitted. Alternative services should take account of patterns of illness and should be acceptable to parents and professionals; cost savings may be marginal.

Gestational Age, Birth Weight, and Risk of Respiratory Hospital Admission in Childhood

“…30,31 Admission rates may be higher from localities with easy access to hospital or vary with clinical and parental thresholds for admission and organization of out of hours primary care services. 32 The rate of emergency hospital admission for respiratory infections in children has increased over the past decade in the United Kingdom. 31 The majority were shortstay admissions, 33,34 suggesting that these were for minor illness episodes that could have been managed in the community.…”

A children's acute respiratory illness scale (CARIFS) predicted functional severity and family burden

“…Much of the literature focuses on the issue of perceived illness threat, which is known to vary with diagnosis, the child's age, and the parent's perception of general health threat, previous experience of illness, and experience as a parent [13]. Kai's study [10] of parents of preschool children cited cough and fever as two specific symptoms that provoked anxiety that their child would be irretrievably harmed, and a recent hospital-based study from the UK reported substantial differences between parental and physician assessment of illness severity on hospital admission [14]. Our findings simply emphasize the clinical importance of recognizing the contextual factors, including the emotional context, of parent assessment of clinical severity of childhood illness.…”

“…Please tick a box for each item (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)) that best suits your child over the last 24 hours. The time period to which the chart referred was either 8 hours (for the first 48 hours) or 24 hours.…”

Clinical training experience in district general hospitals

“…To assess how representative these data might be, we compared frequencies of diagnoses with those in data sets collected during a BPA/RCPCH study in five Yorkshire hospitals,2 3 and in four South of England hospitals during an unpublished study carried out for the National Casemix Office by the BPA in 1995. In addition, we used published epidemiological reports together with data provided by the Public Health Laboratory Service (PHLS) and Department of Health Hospital Episode Statistics (HES) for England.…”