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Interventions in primary and community care to reduce urgent paediatric hospital admissions: systematic review
Smita Dick1, Clare MacRae2, Claire McFaul1
1Department of Child Health, University of Aberdeen, Aberdeen, UK.
Insights
Urgent paediatric hospital admissions are rising. Community-based interventions like telemedicine show promise in reducing emergency department visits and hospital admissions for children.
Area of Science:
- Pediatric Healthcare
- Public Health Interventions
- Health Services Research
Background:
- Rising rates of urgent pediatric hospital admissions necessitate effective interventions.
- Emergency department (ED) visits and hospital admissions for children are a significant concern.
Purpose of the Study:
- To systematically review community-based interventions aimed at reducing pediatric emergency department visits or urgent hospital admissions.
- Evaluate the effectiveness of non-hospital-based care models for children.
Main Methods:
- Systematic literature review of randomized controlled trials (RCTs) and before-and-after studies.
- Searched multiple databases including MEDLINE, Embase, and Cochrane Library.
- Included studies involving individuals under 16 years of age.
Main Results:
- Seven studies were identified, including RCTs and before-and-after designs.
- Telemedicine interventions showed a reduction in pediatric admissions and ED visits in multiple studies.
- Reconfiguration of staff roles had mixed results, while care pathways and point-of-care testing showed no impact.
Conclusions:
- Out-of-hospital urgent care models for children require prompt implementation and evaluation.
- Telemedicine appears to be a promising strategy for reducing pediatric hospitalizations and ED use.
- Further research is needed to optimize community-based care for pediatric urgent needs.
Background:
There has been a rise in urgent paediatric hospital admissions and interventions to address this are required.
Objective:
To systemically review the literature describing community (or non-hospital)-based interventions designed to reduce emergency department (ED) visits or urgent hospital admissions.
Data Sources:
MEDLINE, Embase, OVIS SP, PsycINFO, Science Citation Index Expanded/ISI Web of Science (1981-present), the Cochrane Library database and the Database of Abstracts of Reviews of Effectiveness.
Study Eligibility Criteria:
Randomised controlled trials (RCTs) and before-and-after studies.
Participants:
Individuals aged <16 years.
Study Appraisal And Synthesis Methods:
Papers were independently reviewed by two researchers. Data extraction and the Critical Appraisals Skills Programme checklist was completed (for risk of bias assessment).
Results:
Seven studies were identified. Three studies were RCTs, three were a comparison between non-randomised groups and one was a before-and-after study. Interventions were reconfiguration of staff roles (two papers), telemedicine (three papers), pathways of urgent care (one paper) and point-of-care testing (one paper). Reconfiguration of staff roles resulted in reduction in ED visits in one study (with a commensurate increase in general practitioner visits) but increased hospital admissions from ED in a second. Telemedicine was associated with a reduction in children's admissions in one study and reduced ED admissions in two further studies. Interventions with pathways of care and point-of-care testing did not impact either ED visits or urgent admissions.
Conclusions And Implications:
New out-of-hospital models of urgent care for children need to be introduced and evaluated without delay.
Prospero Registration Number:
CRD42021274374.
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