Four-hour target for emergency departments has led to rise in admissions - study

20 December 2017, 06:37

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Pressure on emergency departments to see patients within four hours has led to a surge in "avoidable" child admissions, according to a new study.

The number of children admitted to hospital in Scotland as emergency referrals rose almost 50% across the 13-year period of data, but researchers found no evidence of a growth in youngsters getting seriously ill.

Of the increased number of admissions who were discharged the same day, the vast majority were usually treated with only clear fluids and paracetamol - which could be done at home.

University of Aberdeen researchers suggest the surge may be due to a number of factors, including pressure on emergency departments to see patients within four hours, which have added unnecessary workloads to hospital staff.

Professor Steve Turner, consultant paediatrician at Royal Aberdeen Children's Hospital, said: "If you go into an emergency department, within four hours a decision has to be made - do we admit or do we not admit them.

"In the old days, emergency departments would be able to observe children and decide whether they have to be admitted, now they have to decide quickly - they don't have the luxury of sitting and watching a child.

"The fact that these children are coming all the way into hospital and then being sent home on the same day after receiving treatment they could have got at home suggests that many emergency admissions are potentially avoidable.

"This is a big problem and something needs to change because numbers of admissions continue to rise.

"Hospital staff are being taken away from other duties to help look after the children being admitted.

"Clearly we all need to provide a safe healthcare service for children, and the paediatric hospital team need to support colleagues in the community.

"If we can better educate parents with clear and easy-to-understand information they may have a clear understanding of when to ask for help and when not to.

"Of course we don't want to put parents off contacting the doctor when they think something is wrong."

The study, published in the European Journal of Pediatrics, found the number of paediatric emergency admissions increased 49% between 2000 and 2013.

It went from 36/1,000 children to 54/1,000 by the end of the period.

However, the number of those discharged on the same day surged by 186% during the same time - from 8.6/1,000 to 24.6/1,000.

Professor Turner said experts working in primary care, emergency department and the out-of-hours service need to have more options open to them other than "admit or not".

This includes using facilities such as video conferencing to avoid sometimes long and potentially avoidable trips to hospital.

Next-day appointments for children who have been unwell for a few days but are not seriously unwell was another idea put forward.

The Royal College of GPs has acknowledged its members could benefit from more training and support in caring for children who are unwell.

Deputy chief medical officer Dr Gregor Smith said: "The decision whether to admit or not is often not straightforward.

"The introduction of day assessment facilities on many children's wards has been a positive development that allows full assessment of children who are unwell in an appropriate, supportive environment for families and carers by staff who are familiar with this type of care.

"Some of these children will subsequently be discharged."