The researchers are calling for introducing a Hospital at Home service for eligible children, similar to that implemented in England, to reduce the unsustainable stress on hospitals.
Treating unwell children at home who don’t need a hospital admission eases pressure on an already strained health service. It is usually more convenient and comfortable for young people and their parents.
The current sustained increase in paediatric admissions has been attributed to several factors:
- Parental health-seeking behaviour is changing,
- The capacity of community care, such as GPs and NHS24, to meet the need is under pressure,
- Hospitals are sending children home earlier, which means more end up returning.
Dr Smita Dick and Professor Stephen Turner are trying to find ways to slow and potentially even reverse this trend.
Dr Dick and Professor Turner published two papers in which they reviewed all the scientific literature published since 2000 that looked at different ways of providing care for unwell children which might avoid an emergency hospital admission.
They looked at several alternative ways to assess unwell children, including:
- The inclusion of a short-stay observation area in hospitals,
- Placing senior paediatricians in the Emergency Department
- Having out-of-hours general practitioners as an alternative to the emergency department
- Telemedicine between GPs and the receiving hospital clinician.
In addition, they reviewed existing agreed pathways of care documents – plans that state what treatment plan should be followed.
The research found that overall there was no evidence that these alternatives work except telemedicine which shows considerable promise.
Dr Dick explains: “There was not a lot of research published. We found that, where research was available, telemedicine might effectively reduce the need to have an admission. Still, 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 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 approaches have been taken, but most don’t work. We have highlighted what probably does not work.”
Other research has shown that one such intervention that has been successful in reducing older adult admissions is the Hospital at Home service. In the elderly, the Hospital at Home service is well known to reduce hospital admissions by providing treatments in the comfort and familiarity of their home.
The service enables people to receive treatments that would otherwise require admissions to the hospital, such as an intravenous drip or oxygen supply. It also provides access to hospital tests under the care of a consultant in their own home.
Dr Dick suggests this may be an alternative to admission for children: “In Scotland today, there is 15 Hospital at Home beds per 100,000 adults, with an ambition to rise to 40-50 beds. Currently, there is 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.”