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Organisational models at the emergency department to reduce hospital admissions among paediatric patients: a systematic literature review
European Journal of Emergency Medicine ( IF 4.4 ) Pub Date : 2022-10-01 , DOI: 10.1097/mej.0000000000000947
Jens Detollenaere 1 , Carine Van de Voorde 1 , Koen Van den Heede 1, 2
Affiliation  

Paediatric attendances at the emergency department (ED) are often admitted to the hospital less than 24 h to allow time for more extended evaluation. Innovative organisational models could prevent these hospital admissions without compromising safety or quality of delivered care. Therefore, this systematic review identifies evidence on organisational models at the ED with the primary aim to reduce hospital admissions among paediatric patients. Following the PRISMA guidelines, three bibliographic databases (Ovid Medline, Embase, and Cochrane Library) were searched. Studies on organisational models in Western countries, published between January 2009 and January 2021, which applied a comparative design or review and studied at least hospital admission rates, were included. Analyses were mainly descriptive because of the high heterogeneity among included publications. The primary outcome is hospital admission rates. Secondary outcomes are ED length of stay (LOS), waiting time, and patient satisfaction. Sixteen publications described several innovative organisational models ranging from the creation of dedicated units for paediatric patients, innovative staffing models to bringing paediatric critical care physicians to patients at rural EDs. However, the effect on hospital admission rates and other outcomes are inconclusive, and some organisational models may improve certain outcomes in certain settings or vice versa. It appears that a paediatric consultation liaison team has the most consistent effect on hospital admission rates and LOS of paediatric patients presenting with mental problems at the ED. Implementing new innovative organisational models at the ED for paediatric patients could be worthwhile to decrease hospital admissions. However, the existing evidence is of rather weak quality. Future service developments should, therefore, be conducted in a way that allows objective evaluation.



中文翻译:

减少儿科患者住院率的急诊科组织模式:系统文献综述

急诊科 (ED) 的儿科护理人员通常会在 24 小时内入院,以便有时间进行更长时间的评估。创新的组织模式可以在不影响所提供护理的安全或质量的情况下防止这些住院。因此,本系统评价确定了急诊部组织模式的证据,其主要目的是减少儿科患者的住院率。按照 PRISMA 指南,搜索了三个书目数据库(Ovid Medline、Embase 和 Cochrane Library)。纳入了 2009 年 1 月至 2021 年 1 月期间发表的西方国家组织模式研究,这些研究应用了比较设计或审查,至少研究了住院率。分析主要是描述性的,因为纳入的出版物之间存在高度异质性。主要结果是住院率。次要结果是 ED 住院时间 (LOS)、等待时间和患者满意度。16 篇出版物描述了几种创新的组织模式,从为儿科患者创建专门的单位、创新的人员配备模型到将儿科重症监护医生带到农村急诊室的患者。然而,对住院率和其他结果的影响尚无定论,一些组织模式可能会在某些情况下改善某些结果,反之亦然。儿科会诊联络小组似乎对在急诊室出现精神问题的儿科患者的住院率和 LOS 具有最一致的影响。在急诊部为儿科患者实施新的创新组织模式可能有助于减少住院率。然而,现有证据的质量相当薄弱。因此,未来的服务开发应该以允许客观评估的方式进行。

更新日期:2022-09-05
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