The association between opening a short stay paediatric assessment unit and trends in short stay hospital admissions
Abstract Background. Rising acute paediatric hospital admissions in Scotland are explained by rising numbers of admissions lasting less than 24 hours (zero day admissions). Many inpatient facilities in Scotland have opened short stay paediatric assessment units (SSPAU) which are clinical areas separate from the usual inpatient ward area and these are where most zero day admissions are accommodated. Here we describe the effect of opening short stay paediatric assessment units (SSPAU) on the proportion of zero day admissions relative to all emergency admissions.Methods. Details of all emergency medical paediatric admissions to Scottish hospitals between 2000 and 2013 were obtained, including the number of zero day admissions per month and health board (i.e. geographic region). The month and year that an SSPAU opened in each health board was provided by local clinicians.Results. SSPAUs opened in 7 health boards, between 2004 and 2012. The rise in zero day admissions was greater in health boards with no SSPAU compared to those with an SSPAU. Across all 7 health boards, opening an SSPAU was associated with a 13% [95% CI 10, 15] increase in the proportion of zero day admissions. When considered individually, zero day admissions rose in four health boards after their SSPAU opened, were unchanged in one and fell in two health boards. Independent of SSPAUs opening, there was an increase in the proportion of all admissions which were zero day admissions (0.1% per month), and this accelerated after SSPAUs opened.Conclusion. Opening an SSPAU may increase in the proportion of zero day admissions, but in some settings may reduce this proportion. Zero day admissions could be reduced in some health boards by understanding differences in clinical referral pathways between health boards with contrasting trends in zero day admissions after their SSPAU opens.