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Paediatric short stay unit in a community hospital: effective, efficient and popular
Sandy M Hopper1, Peter Archer, Richard Breene
1Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Victoria
Area of Science:
- Pediatric Emergency Medicine
- Hospital Management
- Healthcare Delivery Models
Background:
- Short stay medicine offers a cost-effective approach for managing suitable patients.
- Paediatric acute illness and injury can be effectively managed with short stay medicine.
- Prior to 2004, Maroondah Hospital transferred approximately 700 children annually due to a lack of inpatient pediatric care.
Purpose of the Study:
- To describe the implementation and performance of Victoria's first pediatric short stay unit (SSU).
- To address the issue of high patient transfer rates for pediatric care.
- To evaluate the efficiency and patient satisfaction of a new SSU model.
Main Methods:
- Audit of pediatric emergency attendances, admissions, transfers, and discharges at a 291-bed metropolitan hospital.
- Implementation of safety measures including exclusion criteria and care pathways.
- Collection of quality and consumer satisfaction data through telephone surveys.
Main Results:
- The pediatric short stay unit (SSU) admitted 862 out of 1101 children requiring inpatient care over 12 months, reducing transfers by 78%.
- Median length of stay was 20 hours, with 3% unexpected transfers and 8% long stays (>48 hours).
- Patient satisfaction was overwhelmingly positive, with 8% unplanned representations.
Conclusions:
- A co-located pediatric short stay unit (SSU) within an emergency department (ED) is an efficient and viable model for suburban settings.
- The SSU model effectively manages pediatric services, improving in-house care.
- Senior emergency physician cover is recommended over an after-hours junior staff-only model for optimal SSU performance.
Objectives:
Short stay medicine is a cost-effective and efficient way to manage patients with suitable conditions. Paediatric acute illness and injury are amenable to short stay medicine. Before January 2004, when Maroondah Hospital recommenced inpatient care for children, 700 children were transferred annually to other hospitals. We describe the implementation and performance of the first paediatric short stay unit (SSU) in Victoria, which was designed to remedy this situation.
Methods:
Set in a 291-bed metropolitan hospital, we audited paediatric emergency attendances, admissions, transfers and discharges. We present quality and consumer satisfaction data.
Results:
The environment was designed for the physical, developmental and social needs of children. We implemented education, a system of exclusion criteria and pathways to enhance safety. Over 12 months, of 9097 paediatric attendances, 1101 required inpatient care. Among them, 862 patients were admitted to the SSU and 239 were transferred. Accordingly, 78% of admitted patients were cared for in-house. Median length of stay was 20 h. Of the 708 reviewed cases, there were 19 (3%) unexpected transfers from the SSU, 59 (8%) long stays (>48 h) and no deaths. Via a telephone survey, there were 30/355 (8%) unplanned representations and satisfaction data were overwhelmingly positive. We suggest that this model is suitable for centres with limited paediatric cover. In-house senior emergency physician cover might be preferable to an after-hours junior staff-only model.
Conclusion:
A co-located paediatric SSU within an ED is an efficient, popular and viable alternative for paediatric services to be delivered in a suburban setting.
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