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Multi-Stakeholder Informed Guidelines for Direct Admission of Children to Hospital
JoAnna K Leyenaar1, Megan Shevenell2, Paul A Rizzo3
1Department of Pediatrics , The Dartmouth Institute For Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH; Graduate Program in Clinical and Translational Science, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA.
Insights
Pediatric direct admission guidelines were developed through stakeholder discussions and a Delphi approach, focusing on communication, resources, and family needs to improve hospital admission safety and effectiveness.
Area of Science:
- Pediatric healthcare
- Health services research
- Quality improvement
Background:
- Hospital admission processes for children require standardized guidelines.
- Evaluating the safety and effectiveness of pediatric admissions is crucial.
- Multistakeholder perspectives are vital for optimizing care transitions.
Purpose of the Study:
- To develop pediatric direct admission guidelines.
- To prioritize outcomes for evaluating hospital admission safety and effectiveness.
Main Methods:
- Deliberative discussions with parents, physicians, and nurses across three hospitals.
- Analysis of discussions using a general inductive approach.
- National panel prioritization of guideline components and outcomes via a RAND/UCLA Modified Delphi approach.
Main Results:
- Identified key themes: communication, resources, written guidelines, and family needs.
- Endorsed 71 guideline components and 13 outcomes for pediatric direct admissions.
- Guideline components include pre-admission communication, written criteria, hospital resources, pediatric-specific considerations, family communication, and quality reviews.
Conclusions:
- Developed adaptable direct admission guidelines for hospitals and health systems.
- Multistakeholder engagement can enhance hospital admission processes and care transitions.
- Guidelines aim to improve the safety, effectiveness, and integration of pediatric hospital admissions.
Objectives:
To develop pediatric direct admission guidelines and prioritize outcomes to evaluate the safety and effectiveness of hospital admission processes.
Study Design:
We conducted deliberative discussions at 1 children's hospital and 2 community hospitals, engaging parents of hospitalized children and inpatient, outpatient, and emergency department physicians and nurses to identify shared and dissenting perspectives regarding direct admission processes and outcomes. Discussions were audio-recorded, professionally transcribed, and analyzed using a general inductive approach. We then convened a national panel to prioritize guideline components and outcome measures using a RAND/UCLA Modified Delphi approach.
Results:
Forty-eight stakeholders participated in 6 deliberative discussions. Emergent themes related to effective multistakeholder communication, resources needed for high quality direct admissions, written direct admission guidelines, including criteria to identify children appropriate for and inappropriate for direct admission, and families' needs. Building on these themes, Delphi panelists endorsed 71 guideline components as both appropriate and necessary at children's hospitals and community hospitals and 13 outcomes to evaluate hospital admission systems. Guideline components include (1) pre-admission communication, (2) written guidelines, (3) hospital resources to optimize direct admission processes, (4) special considerations for pediatric populations that may be at particular risk of nosocomial infection and/or stress in emergency departments, (5) communication with families referred for direct admission, and (6) quality reviews to evaluate admission systems.
Conclusions:
These direct admission guidelines can be adapted by hospitals and health systems to inform hospital admission policies and protocols. Multistakeholder engagement in evaluation of hospital admission processes may improve transitions of care and health system integration.
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