Interventions to reduce acute paediatric hospital admissions: a systematic review

Background. Admission rates are rising despite no change to burden of illness and interventions toreduce unscheduled admission to hospital safely may be justified.Objective. To systematically examine admission prevention strategies and report long-term followup of admission prevention initiatives.Data sources. MEDLINE, Embase, OVID SP, Psych INFO, Science Citation Index Expanded/ISI Web ofScience, The Cochrane Library from inception to time of writing. Reference lists were hand searched.Study eligibility criteria. Randomised controlled trials (RCTs) and before-and-after studies.Participants. Individuals aged <16 years.Study appraisal and synthesis methods. Studies were independently screened by two reviewerswith final screening by a third. Data extraction and the Critical Appraisals Skills Programme checklistcompletion (for risk of bias assessment) were performed by one reviewer and checked by a second.Results. Twenty-eight studies were included of whom 24 were before-and-after studies and fourwere studies comparing outcomes between non-randomised groups. Interventions included referralpathways, staff reconfiguration, new healthcare facilities and telemedicine. The strongest evidencefor admission prevention was seen in asthma specific referral pathways (n=6) showing 34% [95%CI28-39] reduction, but with evidence of publication bias. Other pathways showed inconsistent resultsor were insufficient for wider interpretation. Staffing reconfiguration showed reduced admissions intwo studies, and shorter length of stay (LOS) in one. Short stay admission units reduced admissionsin all studies.Conclusions and implications. There is little robust evidence to support interventions aimed atpreventing paediatric admissions and further research is needed.