Dick S, MacRae C, McFaul C, et al. Interventions in primary and community care to reduce urgent paediatric hospital admissions: systematic review. Arch Dis Child. 2023 Jun;108(6):486-491. doi: 10.1136/archdischild-2022-324986. Epub 2023 Feb 17. (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 <16 years.

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.


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Discipline Area Score
Physician 5 / 7
Nurse 5 / 7
Comments from MORE raters

Physician rater

Useful article especially when telemedicine did not seem to be as beneficial as reconfiguration of roles. Low-middle-income countries have a shortage of doctors and group practices may offer a solution as it will avoid exhaustion of staff and potentially reduce hospital Emergency Department visits with costly admission that is usually met with out-of-pocket payments.

Physician rater

A study that highlights the lack of evidence, and possibly research, in this area with a huge potential relevant impact in public health.

Physician rater

This systematic review evaluated out-of-hospital interventions to reduce pediatric interventions. The authors included 7 studies (3 RCTs). The interventions included staff role reconfigurations, telemedicine, pathways of care, and point-of-care testing. Care pathways and POC testing did not impact ED visits vs admission. Telemedicine reduced admission in 1 study and ED visits in 2 studies. Reconfiguring staff roles decreased ED visits in one study but increased admissions in another. This meta-analysis demonstrates the need for further study in this area.
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