Abstract
Background
Direct admissions account for 25% of pediatric unscheduled hospitalizations. Despite
this, our knowledge of direct admission practices and safety is limited. This study
aimed to characterize direct admission practices, benefits, and challenges at a diverse
sample of hospitals and to identify diagnoses most appropriate for this admission
approach.
Methods
We conducted a national survey at a stratified random sample of 177 US hospitals using
both closed and open-ended questions. Descriptive statistics were calculated to summarize
numeric responses, while qualitative content analysis was performed to identify emergent
themes.
Results
Responses were received from 108 hospitals (61%). Hospitals represented all geographic
regions and employed varied emergency medicine and inpatient care models. One hundred
three respondents (95%) reported that their hospitals accepted direct admissions,
and 45 (50%) expressed the view that more children should be admitted directly. Perceived
benefits included the following: improved efficiency; patient and physician satisfaction;
earlier access to pediatric-specific care; continuity of care; and reduced risk of
nosocomial infection. Risks and challenges included the following: difficulties determining
admission appropriateness; inconsistent processes; provision of timely care; and patient
safety. Populations and diagnoses reported as most appropriate and inappropriate for
direct admission varied considerably across respondents.
Conclusions
While respondents described benefits of direct admission for both patients and health
care systems, many also reported challenges and safety concerns. Our results may inform
subsequent epidemiologic and patient-centered outcomes research to evaluate the safety
and effectiveness of direct admissions.
Keywords
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Article Info
Publication History
Published online: August 17, 2015
Accepted:
July 3,
2015
Received:
March 28,
2015
Footnotes
The authors declare that they have no conflict of interest.
Identification
Copyright
© 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
