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Paediatric hospital admission processes and outcomes: a qualitative study of parents' experiences and priorities
JoAnna K Leyenaar1,2, Paul A Rizzo3, Emily R O'Brien4
1Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.
Insights
Hospital admissions are a critical care transition. This study explored parents
Area of Science:
- Biomedical and Health Sciences
- Public Health
- Health Services Research
Background:
- Hospital admission signifies a critical transition in care, involving changes in setting, providers, and management.
- While hospital discharge to home has received significant attention, transitions into hospital remain under-focused.
- Understanding patient and family experiences during hospital admission is crucial for improving care continuity.
Purpose of the Study:
- To characterize family experiences during transitions from outpatient to inpatient care for children with ambulatory care-sensitive conditions.
- To identify key hospital admission processes and outcomes prioritized by families.
- To compare parental perspectives on hospital admission between direct admissions and those via emergency departments (ED).
Main Methods:
- Semistructured interviews were conducted with parents of hospitalized children across four diverse hospitals.
- Interviews explored pre-admission care, decision-making processes for admission, and parental preferences for admission processes and outcomes.
- Verbatim interview transcripts were analyzed using a general inductive approach.
Main Results:
- 48 interviews revealed children had a median of two pre-admission healthcare encounters in the preceding week, with 44% utilizing multiple care settings.
- Healthcare utilization patterns were influenced by disease acuity, access to care, prior experiences, and differing views on primary care and ED roles.
- Parental priorities for hospital admission included effective clinical care, efficient processes, safety, timeliness, and patient/family-centered care.
Conclusions:
- Families experienced pre-admission care across various settings with inconsistent care coordination.
- Improvements in hospital admission systems are needed to enhance health system integration and continuity of care.
- This research provides insights to guide the optimization of hospital admission processes.
Background:
Hospital admission, like hospital discharge, represents a transition of care associated with changes in setting, healthcare providers and clinical management. While considerable efforts have focused on improving the quality and safety of hospital-to-home transitions, there has been little focus on transitions into hospital.
Objectives:
Among children hospitalised with ambulatory care sensitive conditions, we aimed to characterise families' experiences as they transitioned from outpatient to inpatient care, identify hospital admission processes and outcomes most important to families and determine how parental perspectives differed between children admitted directly and through emergency departments (ED).
Methods:
We conducted semistructured interviews with parents of hospitalised children at four structurally diverse hospitals. We inquired about preadmission healthcare encounters, how hospital admission decisions were made and parents' preferences regarding hospital admission processes and outcomes. Interviews were transcribed verbatim and analysed using a general inductive approach.
Results:
We conducted 48 interviews. Participants were predominantly mothers (74%); 45% had children with chronic illnesses and 52% were admitted directly. Children had a median of two (IQR 1-3) healthcare encounters in the week preceding hospital admission, with 44% seeking care in multiple settings. Patterns of healthcare utilisation were influenced by (1) disease acuity and healthcare access; (2) past experiences; and (3) varied perspectives about primary care and ED roles as hospital gatekeepers. Participants' hospital admission priorities included: (1) effective clinical care; (2) efficient admission processes; (3) safety and security; (4) timeliness; and (5) patient and family-centred processes of care.
Conclusions:
Families received preadmission care in several settings and described varying degrees of care coordination during their admission processes. This research can guide improvements in hospitals' admission systems, necessary to achieve health system integration and continuity of care.