Bed Utilisation in an Irish Regional Paediatric Unit – A Cross-Sectional Study Using the Paediatric Appropriateness Evaluation Protocol (PAEP)

Document Type : Original Article

Authors

1 Department of Public Health, Health Service Executive, Dublin, Ireland

2 Statistical Consulting Unit, University of Limerick, Limerick, Ireland

3 Regional Paediatric Unit (Children’s Ark), University Hospital Limerick (UHL), Limerick, Ireland

Abstract

Background
Increasing demand for limited healthcare resources raises questions about appropriate use of inpatient beds. In the first paediatric bed utilisation study at a regional university centre in Ireland, we conducted a cross-sectional study to audit the utilisation of inpatient beds at the Regional Paediatric Unit (RPU) in University Hospital Limerick (UHL), Limerick, Ireland and also examined hospital activity data, to make recommendations for optimal use of inpatient resources.
 
Methods
We used a questionnaire based on the paediatric appropriateness evaluation protocol (PAEP), modified and validated for use in the United Kingdom, to prospectively gather data regarding reasons for admission and for ongoing care after 2 days, from case records for all inpatients during 11 days in February (winter) and 7 days in May–June (summer). We conducted bivariate and multivariate analysis to explore associations between failure to meet PAEP criteria and patient attributes including age, gender, admission outside of office hours, arrival by ambulance, and private health insurance. Inpatient bed occupancy and day ward activity were also scrutinised.
 
Results
Mean bed occupancy was 84.1%. In all, 12/355 (3.4%, 95% CI: 1.5%–5.3%) of children failed to meet PAEP admission criteria, and 27/189 (14.3%, 95% CI: 9.3%–19.3%) who were still inpatients after 2 days failed to meet criteria for ongoing care. 35/355 (9.9%, 95% CI: 6.8%–13.0%) of admissions fulfilled only the PAEP criterion for intravenous medications or fluid replacement. A logistic regression model constructed by forward selection identified a significant association between failure to meet PAEP criteria for ongoing care 2 days after admission and admission during office hours (08.00–17.59) (P = .020), and a marginally significant association between this outcome and arrival by ambulance (P = .054).
 
Conclusion
At a mean bed occupancy of 84.1%, an Irish RPU can achieve 96.6% appropriate admissions. Although almost all inpatients met PAEP criteria, improvements could be made regarding emergency access to social services, management of parental anxiety, and optimisation of access to community-based services. Potential ways to provide nasogastric or intravenous fluid therapy on an ambulatory basis, and outpatient antimicrobial therapy (OPAT) should be explored. Elective surgical admissions should adhere to day-of-surgery admissions (DOSA) policy.

Keywords

Main Subjects

References

  1. Fieldston ES, Hall M, Sills MR, et al. Children's hospitals do not acutely respond to high occupancy. Pediatrics. 2010;125(5):974-981. doi:10.1542/peds.2009-1627
  2. Werneke U, MacFaul R. Evaluation of appropriateness of paediatric admission. Arch Dis Child. 1996;74(3):268. doi:10.1136/adc.74.3.268
  3. Kreger BE, Restuccia JD. Assessing the need to hospitalize children: pediatric appropriateness evaluation protocol. Pediatrics. 1989;84(2):242-247.
  4. Esmail A. Development of the paediatric appropriateness evaluation protocol for use in the United Kingdom. J Public Health. 2000;22(2):224-230. doi:10.1093/pubmed/22.2.224
  5. Werneke U, Smith H, Smith IJ, Taylor J, MacFaul R. Validation of the paediatric appropriateness evaluation protocol in British practice. Arch Dis Child. 1997;77(4):294-298. doi:10.1136/adc.77.4.294
  6. Formby D, McMullin N, Danagher K, Oldham D. The appropriateness evaluation protocol: Application in an Australian children's hospital. Aust Clin Rev. 1991;11:123-131.
  7. Waldrop R, Peck G, Hutchinson S, Randall Z. Comparison of pediatric hospitalization using the pediatric appropriateness evaluation protocol at three diverse hospitals in Louisiana. J La State Med Soc. 1998;150(5):211-217.
  8. Esmail A, Quayle J, Roberts C. Assessing the appropriateness of paediatric hospital admissions in the United Kingdom. J Public Health Med. 2000;22(2):231. doi:10.1093/pubmed/22.2.231
  9. Katz M, Warshawsky SS, Porat A, Press J. Appropriateness of pediatric admissions to a tertiary care facility in Israel. Isr Med Assoc J. 2001;3(7):501-503.
  10. Bianco A, Pileggi C, Trani F, Angelillo IF. Appropriateness of admissions and days of stay in pediatric wards of Italy. Pediatrics. 2003;112(1):124-128.
  11. Vincitorio D, Chiaradia G, de Waure C, Kambale JM, La Torre G, Di Stanislao F. Appropriateness of admission and days of stay in pediatric hospital in Ancona, Italy. J Public Health. 2010;18(5):497-503. doi:10.1007/s10389-010-0325-y
  12. Shafik MH, Seoudi TM, Raway TS, Al Harbash NZ, Ahmad M, Al Mutairi HF. Appropriateness of pediatric hospitalization in a general hospital in Kuwait. Med Princ Pract.. 2012;21(6):516-521.
  13. Kemper KJ. Medically inappropriate hospital use in a pediatric population. N Engl  J Med. 1988;318(16):1033. doi:10.1056/nejm198804213181605
  14. Gloor JE, Kissoon N, Joubert GI. Appropriateness of hospitalization in a Canadian pediatric hospital. Pediatrics. 1993;91(1):70-74.
  15. Roy RN, Shrivastava P, Das DK, Saha I, Sarkar AP. Burden of hospitalized pediatric morbidity and utilization of beds in a tertiary care hospital of Kolkata, India. Indian J Community Med. 2012;37(4):252. doi:10.4103/0970-0218.103474
  16. Hillier DF, Parry GJ, Shannon MW, Stack AM. The effect of hospital bed occupancy on throughput in the pediatric emergency department. Ann Emerg Med. 2009;53(6):767-776. e3. doi:10.1016/j.annemergmed.2008.11.024
  17. Morrison AK, Myrvik MP, Brousseau DC, Hoffmann RG, Stanley RM. The relationship between parent health literacy and pediatric emergency department utilization: a systematic review. Acad Pediatr. 2013;13(5):421-429. doi:10.1016/j.acap.2013.03.001
  18. Citizens' Information Board. Charges for hospital services. http://www.citizensinformation.ie/en/health/hospital_services/hospital_charges.html. published 2014.
  19. Turner B. Unwinding the State subsidisation of private health insurance in Ireland. Health Policy. 2015;119(10):1349-1357. doi:10.1016/j.healthpol.2015.08.008
  20. Layte R. Equity in the utilisation of hospital inpatient services in Ireland? An improved approach to the measurement of health need. Econ Soc Rev. 2007;38(2):191.
  21. Organization for Economic Cooperation and Development (OECD) Staff. Health at a Glance 2013 OECD Indicators. OECD;2013.
  22. PA Consulting Group. Acute Hospital Bed Review: Health Service Executive;2007.
  23. Doré-Bergeron MJ, Gauthier M, Chevalier I, McManus B, Tapiero B, Lebrun S. Urinary tract infections in 1- to 3-month-old infants: ambulatory treatment with intravenous antibiotics. Pediatrics. 2009;124(1):16-22.
  24. Meates M. Ambulatory paediatrics—making a difference. Arch Dis Child. 1997;76(5):468-476. doi:10.1136/adc.76.5.468
  25. Beverley DW, Ball RJ, Smith RA, et al. Planning for the future: the experience of implementing a children’s day assessment unit in a district general hospital. Arch Dis Child. 1997;77(4):287-293. doi:10.1136/adc.77.4.287
  26. MacFaul R. Planning for the future: the experience of implementing a children's day assessment unit in a district general hospital-Commentary. Arch Dis Child. 1997;77:287-293. doi:10.1136/adc.77.4.287
  27. Aitken P, Birch S, Cogman G, Glasper EA, Wiltshire M. Quadrennial review of a paediatric emergency assessment unit. Br J Nurs. 2003;12(4):234-241. doi:10.12968/bjon.2003.12.4.11163

Files

History

  • Receive Date: 21 June 2015
  • Revise Date: 02 May 2016
  • Accept Date: 03 May 2016
  • First Publish Date: 01 November 2016

Share

How to cite

Statistics