4.4 Article

The association between opening a short stay paediatric assessment unit and trends in short stay hospital admissions

Journal

BMC HEALTH SERVICES RESEARCH
Volume 21, Issue 1, Pages -

Publisher

BMC
DOI: 10.1186/s12913-021-06541-x

Keywords

Child; Epidemiology; Health services; Hospitalization

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The opening of short stay paediatric assessment units (SSPAU) in Scottish hospitals has varying impacts on the proportion of zero day admissions. While overall there was an increase in the proportion of zero day admissions after SSPAUs opened, some health boards experienced a reduction in zero day admissions. Understanding differences in clinical referral pathways between health boards is crucial for reducing zero day admissions.
Background 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 (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. Methods Details 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. Results SSPAUs 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. Conclusion Opening 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.

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