Alternatives to child hospital admissions insufficient, researchers find

Rising numbers of child admissions to Scottish hospitals are placing “unsustainable” pressure on the health service and alternatives to prevent them are insufficient, new research suggests.

Researchers found many children admitted to hospital as an emergency case are there for less than 24 hours, which suggests many of them could have been treated at home.

They are calling for the introduction of a Hospital at Home service for children in Scotland, similar to that implemented in England, in a bid to reduce the stress on hospitals.

Dr Smita Dick and Professor Stephen Turner, of the University of Aberdeen, have published two papers in which they reviewed all scientific literature published in English since 2000 that looked at different ways of providing care for unwell children which might avoid an emergency hospital admission, but found most did not seem to work.

They looked at a number of alternative ways to assess children who are unwell, including the inclusion of a short-stay observation area in hospitals, or placing senior paediatricians in the emergency department.

They also looked at having out-of-hours general practitioners as an alternative to A&E, and at telemedicine between GPs and the hospital clinician.

Dr Dick said: “There was not a lot of research published. What we found was that, where research was available, it indicated that telemedicine may be effective in reducing the need to have an admission, but the other interventions did not seem to help.

“Hospitals are bursting at the seams and this year-on-year increase is unsustainable. It is vital that we find interventions that actually work.

“Around 60% of children admitted to hospital as an emergency case are in hospital for less than 24 hours. This suggests that many of those children might have been treated at home rather than in hospital.

“We have been looking at different ways of providing care and advice for parents and community-based doctors and nurses looking after unwell children. Many different approaches have been taken but most don’t seem to work.”

The current sustained increase in paediatric admissions has been attributed to several factors, including a change in parental behaviour and the capacity of community care such as GPs and NHS24 being under pressure.

Research also suggests that hospitals are sending children home earlier, which means more end up returning.

The two papers are published in the UK paediatric journal Archives Of Disease In Childhood.

Other research has shown the Hospital at Home service has been successful in reducing older adult admissions.

The service enables people to receive treatment that would otherwise require them to be admitted to hospital, such as an intravenous drip or oxygen supply, and also provides access to hospital tests under the care of a consultant in their own home.

The researchers suggested this could be expanded to include children in Scotland.

Dr Dick said: “In Scotland today there are 15 Hospital at Home beds per 100,000 adults, with an ambition to rise to 40-50 beds. Currently there are no Hospital at Home beds for children in Scotland.

“However, we know that Hospital at Home for children is a success since it has been rolled out in many English towns and cities, it would be great for children and parents if Hospital at Home could be rolled out in Scotland.”

A Scottish Government spokesperson said: “Hospital at Home has already proved to be very successful for both patients and the wider system.

“That’s why we have allocated a further £3.6 million so more people can be managed in their own home rather than in hospital, reducing pressure on A&E and the Scottish Ambulance Service by avoiding admissions and accelerating discharge.

“We are aware of growing international evidence for a paediatric Hospital at Home service, and we are working to understand the approach before plans can be developed which support safe and effective delivery within the Scottish context.”