Hospital-based alternatives to acute paediatric admission: a systematic review

Ogilvie, D. (2005) Hospital-based alternatives to acute paediatric admission: a systematic review. Archives of Disease in Childhood, 90(2), pp. 138-142.

Abstract

Objective: To synthesise published evidence of the impacts of introducing hospital-based alternatives to acute paediatric admission. Design: Systematic review of studies of interventions published in English. Patients: Children with acute medical problems referred to hospitals. Interventions: Services provided in a hospital as an alternative to inpatient admission. Main outcome measures: Admission or discharge, unscheduled returns to hospital, satisfaction of parents and general practitioners, effects on health service activity and costs. Results: 25 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of service reorganisation does not disadvantage children and their families, particularly where inpatient services are withdrawn from a hospital.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Ogilvie, David
• Authors: Ogilvie, D.
• Subjects: R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
• Journal Name: Archives of Disease in Childhood
• Journal Abbr.: Arch. Dis. Child.
• Publisher: B M J Group
• ISSN: 0003-9888
• ISSN (Online): 1468-2044
• Copyright Holders: Copyright © 2005 BMJ Publishing Group & Royal College of Paediatrics and Child Health
• First Published: First published in Archives of Disease in Childhood 90(2):138-142
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher.