Abstract
BackgroundMany inpatient facilities in Scotland have opened short stay paediatric assessment units (SSPAU) which are clinical areas separate from the usual inpatient ward area and these are where most short stay (also called zero day) admissions are accommodated. Here we describe the effect of opening short stay paediatric assessment units (SSPAU) on the proportion of zero day admissions relative to all emergency admissions.MethodsDetails of all emergency medical paediatric admissions to Scottish hospitals between 2000 and 2013 were obtained, including the number of zero day admissions per month and health board (i.e. geographic region). The month and year that an SSPAU opened in each health board was provided by local clinicians.ResultsSSPAUs opened in 7 health boards, between 2004 and 2012. Health boards with an SSPAU had a slower rise in zero day admissions compared to those without SSPAU (0.6% per month [95% CI 0.04, 0.09]. Across all 7 health boards, opening an SSPAU was associated with a 13% [95% CI 10, 15] increase in the proportion of zero day admissions. When considered individually, zero day admissions rose in four health boards after their SSPAU opened, were unchanged in one and fell in two health boards. Independent of SSPAUs opening, there was an increase in the proportion of all admissions which were zero day admissions (0.1% per month), and this accelerated after SSPAUs opened.ConclusionOpening an SSPAU has heterogeneous outcomes on the proportion of zero day admissions in different settings. Zero day admissions could be reduced in some health boards by understanding differences in clinical referral pathways between health boards with contrasting trends in zero day admissions after their SSPAU opens.
Highlights
Many inpatient facilities in Scotland have opened short stay paediatric assessment units (SSPAU) which are clinical areas separate from the usual inpatient ward area and these are where most short stay admissions are accommodated
Healthcare setting In the UK, children are admitted to hospital by one of three routes: first, family doctors who are based in the community and work 8 am-6 pm Monday to Friday; second, out-ofhours staff who provide care in the community outside of General Practitioner (GP) working hours and who may be doctors and include individuals may be relatively inexperienced when it comes to medical decision-making for sick children, e.g. physician assistants; third, emergency department medical staff who assess patients who present directly to hospital
Data were included from a seventh health board (NHS Grampian) which had two inpatient units and where an SSPAU opened in the larger unit but not the smaller unit, Table 1
Summary
Many inpatient facilities in Scotland have opened short stay paediatric assessment units (SSPAU) which are clinical areas separate from the usual inpatient ward area and these are where most short stay ( called zero day) admissions are accommodated. We describe the effect of opening short stay paediatric assessment units (SSPAU) on the proportion of zero day admissions relative to all emergency admissions. Short stay paediatric assessment units (SSPAU) are clinical areas in hospital where children can be observed for a period of up to 24 h during. A systematic review of the literature published in 2005 [4] suggested that SSPAUs might be effective in reducing hospital admissions, but a later. A systematic review of studies from the USA found no significant change in admission numbers after the opening of observation units (similar to SSPAUs), but did cite individual studies which found reduced admissions for some specific conditions including asthma and gastroenteritis after an observation unit opened [2]. A reduction in admissions associated with opening SSPAUs may be due to recategorising clinical presentations, for example a “reduction” might not include a number of children assessed and sent home
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