Background Paediatric patients being admitted to the inpatient units from the emergency departments (EDs) are increasing across many developed countries. However, despite this increase in the proportion of admissions, the mean inpatient length of stay has fallen significantly.
Objectives This study aimed to assess the necessity of one-day paediatric admissions in Singapore. An unnecessary admission is defined as one with no diagnostic test ordered, intravenous medication administered, therapeutic procedure performed or specialty review made in the inpatient unit. With a better understanding, interventions can be implemented to reduce the number of unnecessary admissions.
Methods We retrospectively reviewed the medical records of paediatric patients who were admitted from a general ED of an adult tertiary hospital to a paediatric tertiary hospital within the same healthcare cluster between 1 August 2018 and 30 April 2020. Paediatric patients were defined as age less than 16 years old. One-day admission was defined as an inpatient stay of less than 24 hours from time of admission to discharge. Data fields including demographic, diagnosis, reason for admission, interventions and treatment procedures performed at both the emergency department and inpatient unit were captured in a standardised data collection form and analysed.
Results During the study period, there were 3944 paediatric attendances at the general ED. One thousand one hundred and sixty one (8.3%) paediatric patients were admitted to the inpatient unit of the paediatric tertiary hospital. Among these, 481 (41.4%) were one-day admissions. Upper respiratory tract infection (62, 12.9%), gastroenteritis (60, 12.5%) and head injury (52, 10.8%) were the three most common conditions. The three most common reasons for ED admissions were for inpatient treatment (203, 42.2%), inpatient monitoring (185, 38.5%) and inpatient diagnostic investigations (32, 12.3%). However, 96 (20.0%) one-day admissions (20.0%, n=96) were unnecessary with no diagnostic test ordered, intravenous medication administered, therapeutic procedure performed or specialty review made in the inpatient unit.
Conclusions A fifth of paediatric one-day admission in Singapore has been shown to be unnecessary and reasons behind these admissions were multifactorial. A detailed understanding of these reasons can allow us to propose interventions to safely slow down and perhaps reverse this trend.
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