Hospital based alternatives to acute paediatric admission: a systematic review

• Published in: Archives of disease in childhood Vol. 90; no. 2; pp. 138 - 142
• Main Author: Ogilvie, D
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01-02-2005; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: acute; Acute Disease; admissions; Ambulatory care; Ambulatory Care - methods; assessment units; Child; Child Health; Child health services; Child Health Services - economics; Child Health Services - organization & administration; Children & youth; Clinical outcomes; Comparative analysis; Delivery of Health Care - economics; Delivery of Health Care - methods; Departments; emergency; Emergency medical care; Emergency Service, Hospital - economics; Emergency Service, Hospital - organization & administration; Hospital outpatient services; Hospitalization - economics; Hospitals; Humans; Information Seeking; Observation; Observational studies; Original; Outpatient services; Parents - psychology; Patient Satisfaction; Patients; Pediatrics; Periodicals; Physicians; Qualitative research; Search Strategies; Systematic review; Treatment Outcome; United Kingdom
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.2003.035543

Aims: To synthesise published evidence of the impacts of introducing hospital based alternatives to acute paediatric admission. Methods: Systematic review of studies of interventions for children with acute medical problems. Main outcome measures were: admission or discharge, unscheduled returns to hospital, satisfaction of parents and general practitioners, effects on health service activity, and costs. Results: Twenty five studies were included: one randomised controlled trial, 23 observational or cross-sectional studies, and one qualitative study. Many studies were of uncertain quality or were open to significant potential bias. About 40% of children attending acute assessment units in paediatric departments, and over 60% of those attending acute assessment units in A&E departments, do not require inpatient admission. There is little evidence of serious clinical consequences in children discharged from these units, although up to 7% may subsequently return to hospital. There is some evidence that users are satisfied with these services and that they are associated with reductions in inpatient activity levels and certain hospital costs. Evidence about the impact of urgent outpatient clinics is very limited. Conclusions: Current evidence supports a view that acute paediatric assessment services are a safe, efficient, and acceptable alternative to inpatient admission, but this evidence is of limited quantity and quality. Further research is required to confirm that this type of service reorganisation does not disadvantage children and their families, particularly where inpatient services are withdrawn from a hospital.