Reduction of Inappropriate Hospital Admissions of Children With Influenza-Like Illness Through the Implementation of Specific Guidelines: A Case-Controlled Study

Abstract

ABSTRACT.Background. In an attempt to reduce the burden of influenza-like illness (ILI) on health resources, the Italian Ministry of Health released clinical practice guidelines (CPGs) on ILI management that include specific indications for the admission of children to the hospital. The aim of this study was to evaluate whether application of these CPGs reduced the rate of inappropriate hospital admissions.Methods. In the first phase, 2 independent observers recorded the number and clinical condition of children presenting with ILI to the emergency department (ED) of a large urban pediatric hospital and the main reasons for hospital admission. The latter were compared with the CPG indications for hospital admission to evaluate appropriateness. One year later (phase 2), we recorded the number of children with ILI admitted to the hospital by pediatricians trained in a 3-hour course on CPGs and by "untrained" control pediatricians.Results. In phase 1 of the study, 854 children accessed the ED; 318 (37.2%) had ILI. Of the latter, 26.2% were admitted to the hospital, and 33.7% of admissions were inappropriate according to CPG criteria. In phase 2, 16% of the children with ILI were admitted by CPG-trained pediatricians and 25.8% by control pediatricians. The number of inappropriate hospital admissions was higher among control than among CPG-trained pediatricians.Conclusions. ILI in children is associated with a high rate of inappropriate hospital admissions. Training of ED pediatricians in the application of a specific CPG may result in a substantial decrease of the admission rate and of inappropriate admissions. Pediatrics 2005; 116:e506-e511. URL: www.pediatrics.org/cgi/doi/10.1542/ peds.2005-0053; influenza-like illness, inappropriate admission, guideline, children.ABBREVIATIONS. ILI, influenza-like illness; ED, emergency department; CPG, clinical practice guideline. I nfluenza and influenza-like illnesses (ILI) are a major health problem in terms of morbidity and mortality worldwide. In the last 2 decades, the number of respiratory infection-related hospitalizations has increased substantially, 1 and influenza is responsible for 20 to 50 million cases per year in the United States. 2 Childhood ILI is associated with a high incidence of outpatient visits and hospitalizations. 3 In particular, the so-called influenza season is marked by an overload of visits to emergency departments (EDs), especially in large urban areas. The increase in ED visits is paralleled by an increased number of admissions that frequently overwhelms the capacity of referral hospitals.Inappropriate hospital admission is a major health care problem because of its high rate during influenza and ILI epidemics and because of its negative impact on national health resources and patient management. 4,5 Most studies of inappropriate admissions have been based on application of the Pediatric Appropriateness Evaluation Protocol, a nonspecific tool used to assess compliance with standard criteria for hospital admission and stay. 4,6,7 High rates of ina...

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