Objective Evidence on how best to intervene to improve paediatric acute care and therefore reduce unplanned hospital admissions is weak. We describe service evaluation work at one hospital to assess interventions at critical clinical and service decision points.
Design We conducted an observational study using routine daily-collected data (April 2009–December 2015) from a medium-sized district general hospital in south-west UK, using before-and-after comparisons of admissions-related data to evaluate two interventions implemented in April and November 2014, respectively: (1) an advice and guidance (A&G) phone line, where a senior paediatrician is available for general practitioners (GPs) and emergency department (ED) and (2) a Short Stay Paediatric Assessment Unit (SSPAU). We analysed data on all admitted children (<18 years) in the catchment area (population estimate 27 740 in 2015). Outcomes were GP-referred attendances, ward admissions, less than 1 day admissions and length of stay.
Results A&G phone line was associated with a reduction in the mean number of less than 1 day admissions per month (difference in means before and after intervention −16.6 (95% CI −0.2 to −32.9)) and an increase in overall monthly bed-days (difference 72.5 (95% CI 21.0 to 124.0)), but there was little evidence of a change in GP-referred attendances or ward admissions. SSPAU was associated with a reduction in the mean number of monthly ward admissions (difference −34.6 (95% CI –21.3 to −48.0)) and less than 1 day admissions (difference in means −21.7 (95% CI −8.4 to −35.1)) and a reduction in the mean number of overall bed-days per month (difference −50.2 (95% CI −12.1 to −88.3)).
Conclusions Interventions for reducing time taken to senior clinician review may be effective in better managing paediatric acute care. Further work should explore results by age, condition and injury/illness status.
- health services research
- general paediatrics
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Contributors SL conceived the project. VB managed and led the project and KH was the main researcher. RT is a consultant paediatrician at the hospital, where GS is the operations manager and both assisted with data interpretation. RR identified, collected and processed local data. SB and OCU provided statistical advice.
Funding Intervention costs and RT, GS and RR’s time were funded by the Torbay and South Devon Foundation Hospital. KH, VB, SB, OCU and SL’s time was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Hospital.
Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Competing interests RT, GS and RR are employed by the hospital delivering these interventions.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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