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Effectiveness of multifunction paediatric short-stay units: a French multicentre study
A Najaf-Zadeh1, V Hue, C Bonnel-Mortuaire
1Univ Lille Nord de France, UDSL, France.
Insights
French paediatric short-stay units (SSU) effectively manage sick children, with observation units (OU) showing appropriate admission rates from 52-86%. Key predictors for inappropriate OU admissions include young age and need for advanced diagnostics or monitoring.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Clinical Observation
Background:
- Multifunction paediatric short-stay units (SSU), including observation units (OU), medical assessment and planning units (MAPU), and holding units (HU), are increasingly utilized.
- Understanding their operational characteristics and effectiveness is crucial for optimizing pediatric acute care.
Purpose of the Study:
- To characterize the activities within French paediatric SSUs.
- To evaluate the effectiveness of these units.
- To identify predictors of inappropriate admissions to OU.
Main Methods:
- Analysis of admissions to nine French paediatric SSUs.
- Outcome measures included SSU length of stay and appropriate admission rates for OU patients.
Main Results:
- Observation unit (OU) patients comprised 66% of admissions.
- Appropriate OU admission rates varied from 52% to 86%, with head trauma and seizure having the highest rates (82%).
- Inappropriate OU admissions were linked to younger age (<1 year) and requirements for IV fluids, advanced imaging, or cardiorespiratory monitoring. MAPU and HU had low rates of discharge within 24 hours (18% and 5%, respectively).
Conclusions:
- French paediatric SSUs serve as an effective model for 'observation medicine' within emergency departments.
- These units facilitate diagnostics and early treatment for diverse pediatric conditions.
- The principles and experiences from these units may be transferable to other healthcare systems.
Aim:
To describe the characteristics of the activities of multifunction paediatric 'short-stay units' (SSU) including observation unit (OU), medical assessment and planning unit (MAPU) and holding unit (HU), to evaluate their effectiveness and to explore predictors of inappropriate admissions for OU patients.
Methods:
Admissions to nine French paediatric SSUs were analysed. The main outcome measures were SSU length of stay with associated outcome for all patients and appropriate admission rate for OU patients.
Results:
Of 1084 patients included in the study, 66% were OU patients (n = 718), 21% MAPU patients (n = 225) and 13% HU patients (n = 141). The OU patients constituted the majority of the SSU admissions. The appropriate OU admission rates ranged from 52% to 86%. Head trauma and seizure were the conditions with the highest appropriate OU admission rates (82%). Age <1 year, and need for IV fluids or medications, CT-Scan or MRI and cardiorespiratory monitoring were associated with an increased risk of inappropriate OU admission. Eighteen per cent of the MAPU patients and 5% of the HU patients were discharged home within 24 h.
Conclusion:
By providing extended and easily available facilities for diagnostics and early treatment for a wide range of sick children, the French paediatric SSU is an effective model for 'observation medicine' in emergency department-managed units. The experience and principles may be applicable to similar units in other health care systems.
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