Interventions in primary and community care to reduce urgent paediatric hospital admissions: systematic review

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
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.