Do hospital pressures change following rotavirus vaccine introduction? A retrospective database analysis in a large paediatric hospital in the UK

• Published in: BMJ open Vol. 9; no. 5; p. e027739
• Main Authors: Heinsbroek, Ellen, Hungerford, Daniel, Cooke, Richard P D, Chowdhury, Margaret, Cargill, James S, Bar-Zeev, Naor, French, Neil, Theodorou, Eleni, Standaert, Baudouin, Cunliffe, Nigel A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-05-2019; BMJ Publishing Group
• Subjects: Adolescent; Age; Bed Occupancy - statistics & numerical data; Child; Child, Preschool; Cross Infection - epidemiology; Disease; Epidemiology; Female; Gastroenteritis; Gastroenteritis - epidemiology; Health Services Research; Hospitalization - statistics & numerical data; Hospitals; Hospitals, Pediatric - statistics & numerical data; Humans; Immunization; Infant; Interrupted Time Series Analysis; Laboratories; Male; Nosocomial infections; Patients; Pediatrics; Retrospective Studies; Rotavirus; Rotavirus Infections - epidemiology; Rotavirus Infections - prevention & control; Rotavirus Vaccines - therapeutic use; United Kingdom - epidemiology; Vaccination - statistics & numerical data; Vaccines; Viruses; United Kingdom; United Kingdom > UK; England; Wales; epidemiology; nosocomial infections; hospital; rotavirus; quality in health care
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-027739

ObjectiveHospitals in the UK are under increasing clinical and financial pressures. Following introduction of childhood rotavirus vaccination in the UK in 2013, rotavirus gastroenteritis (RVGE) hospitalisations reduced significantly. We evaluated changes in ‘hospital pressures’ (demand on healthcare resources and staff) following rotavirus vaccine introduction in a paediatric setting in the UK.DesignRetrospective hospital database analysis between July 2007 and June 2015.SettingA large paediatric hospital providing primary, secondary and tertiary care in Merseyside, UK.ParticipantsHospital admissions aged <15 years. Outcomes were calculated for four different patient groups identified through diagnosis coding (International Classification of Disease, 10th edition) and/or laboratory confirmation: all admissions; any infection, acute gastroenteritis and RVGE.MethodsHospital pressures were compared before and after rotavirus vaccine introduction: these included bed occupancy, hospital-acquired infection rate, unplanned readmission rate and outlier rate (medical patients admitted to surgical wards due to lack of medical beds). Interrupted time-series analysis was used to evaluate changes in bed occupancy.ResultsThere were 116 871 admissions during the study period. Lower bed occupancy in the rotavirus season in the postvaccination period was observed for RVGE (−89%, 95% CI 73% to 95%), acute gastroenteritis (−63%, 95% CI 39% to 78%) and any infection (−23%, 95% CI 15% to 31%). No significant overall reduction in bed occupancy was observed (−4%, 95% CI −1% to 9%). No changes were observed for the other outcomes.ConclusionsRotavirus vaccine introduction was not associated with reduced hospital pressures. A reduction in RVGE hospitalisation without change in overall bed occupancy suggests that beds available were used for a different patient population, possibly reflecting a previously unmet need.Trials registration number NCT03271593