Preventing paediatric admissions for respiratory disease: a qualitative analysis of the views of health care professionals

Abstract

The number of emergency paediatric admissions is increasing each year. The reasons for this are unclear but may include increasing demand from parents, changes in GP working patterns, and an increase in unnecessary admissions. Respiratory disease is the commonest diagnostic category for emergency admission in childhood. To generate hypotheses for reduction in unnecessary admissions for respiratory disease by qualitative analysis of the views of health care professionals, to determine the proportion of preventable admissions as perceived by clinicians, and to assess the modified Paediatric Appropriateness Evaluation Protocol against clinicians judgements of appropriateness of admission. Eight health care professionals analysed clinical data from primary and secondary care for 94 cases that were admitted to an emergency assessment unit and received a hospital discharge diagnosis of respiratory disease. They assessed whether each admission was appropriate, whether it was preventable, and how it might have been prevented. A total of 31% of cases admitted to the assessment unit (29/94) were classified as preventable by the majority of professionals assessing the case. Provision of additional support, monitoring, and observation in the community was cited as a means of prevention in 33/94 cases. There was poor agreement between the modified PAEP and clinicians' assessments of appropriateness of admission (kappa 0.1). If the agreed views of these experienced doctors and nurses are correct, provision of additional services in the community could be an important means of preventing emergency admissions for respiratory disease. This hypothesis should be tested by further research including the views of families. The study provides further evidence that the modified PAEP may not be valid for use in UK practice. If inappropriate admission rates are to be used to measure effectiveness of services we need to develop an objective measure of appropriateness valid for use in the UK.