RESEARCHERS are calling for 'hospital at home' services to be expanded to include children in Scotland amid an "unsustainable" increase in paediatric admissions.
Urgent hospital admissions for children - especially infants - have been on the rise across the UK for more than a decade, reaching record levels, but with hospitals "bursting at the seams" researchers based in Aberdeen said "there is a need for interventions to safely slow this rise".
The National Audit Office (NAO) has previously suggested that 20 per cent of urgent admissions could be managed in the community, rising to as high as 50% in children.
The Hospital at Home service is well known to reduce hospital admissions for elderly patients by providing care in the comfort and familiarity of their own home.
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The service enables people to receive treatments that would otherwise require them to be admitted to hospital, such as an intravenous drip or oxygen supply, and can also enable access to hospital tests under the care of a consultant in their own home.
Dr Smita Dick, a clinician and expert in child health at Aberdeen University, said this could offer an alternative to paediatric hospital admissions.
She said: “In Scotland today there are 15 Hospital at Home beds per 100,000 adults, with an ambition to rise to 40-50 beds. Currently there are 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.”
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Dr Dick and her colleague, Dr Steve Turner, carried out a review of the existing evidence from around the world to analyse how to tackle the issue of rising hospital admissions among under-16s.
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Their findings have been published in two separate papers in the BMJ journal, Archives of Disease in Childhood.
They write that "new out-of-hospital models of urgent care for children need to be introduced and evaluated without delay", including telemedicine.
They found that the use of telemedicine - including nurse-led telephone consultations, videoconferencing, and offering telemedicine to staff working in childcare and primary school settings - reduced A&E visits overall while increasing the use of healthcare by "impoverished inner-city children".
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Telemedicine delivered a reduction in "both the number of acute admissions within three days of the intervention, the costs associated with hospital admission and a reduction in number of [Emergency Department] attendances".
Other interventions - such as out-of-hours GPs as an alternative to the emergency department (ED), redeploying senior paediatricians to the ED, or creating a short-stay observation area - did not appear beneficial.
Their analysis of data from Scottish mainland hospitals between 2015 and 2017 found that 54% of paediatric admissions were "short-stay" - where admission and discharge occurs within 24 hours.
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Around half of all paediatric admissions were caused by 10 common ailments, including asthma, bronchiolitis, convulsions, croup, gastroenteritis, upper respiratory tract infection (URTI), viral infection, tonsillitis, lower respiratory tract infection (LRTI) and admissions with a diagnosis of cough, wheeze or shortness of breath.
Short-stay admissions (SSAs) are to blame for most of the rise in urgent paediatric admissions.
Several possible reasons are given, including changes in parental health-seeking behaviour; the capacity of other services such as GPs or NHS24 to cope with demand, resulting in more avoidable referrals to A&E; and hospitals sending children home earlier to free up beds, which means more end up returning.
Researchers identified more than 6000 cases of under-16s undergoing two separate hospital admissions on the same day.
Dr Dick added: “There was not a lot of research published. What we found was that, where research was available, it indicated that telemedicine may be effective in reducing the need to have an admission, but 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 actually 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 different approaches have been taken but most don’t seem to work. We have highlighted what probably does not work."
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