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Short stay hospital admissions for an acutely unwell child: A qualitative study of outcomes that matter to parents and professionals

Malcolm, Cari; King, Emma; France, Emma; Kyle, Richard G.; Kumar, Simita; Dick, Smita; Wilson, Philip; Aucott, Lorna; Turner, Stephen W.; Hoddinott, Pat

Authors

Cari Malcolm

Emma King

Emma France

Richard G. Kyle

Simita Kumar

Smita Dick

Philip Wilson

Lorna Aucott

Stephen W. Turner

Pat Hoddinott



Abstract

Background
Numbers of urgent short stay admissions (SSAs) of children to UK hospitals are rising rapidly. This paper reports on experiences of SSAs from the perspective of parents accessing urgent care for their acutely unwell child and of health professionals referring, caring for, or admitting children.

Methods
A qualitative interview study was conducted by a multi-disciplinary team with patient and public involvement (PPI) to explore contextual factors relating to SSAs and better understand pre-hospital urgent care pathways. Purposive sampling of Health Board areas in Scotland, health professionals with experience of paediatric urgent care pathways and parents with experience of a SSA for their acutely unwell child was undertaken to ensure maximal variation in characteristics such as deprivation, urban-rural and hospital structure. Interviews took place between Dec 2019 and Mar 2021 and thematic framework analysis was applied.

Results
Twenty-one parents and forty-eight health professionals were interviewed. In the context of an urgent SSA, the themes were centred around shared outcomes of care that matter. The main outcome which was common to both parents and health professionals was the importance of preserving the child’s safety. Additional shared outcomes by parents and health professionals were a desire to reduce worries and uncertainty about the illness trajectory, and provide reassurance with sufficient time, space and personnel to undertake a period of skilled observation to assess and manage the acutely unwell child. Parents wanted easy access to urgent care and, preferably, with input from paediatric-trained staff. Healthcare professionals considered that it was important to reduce the number of children admitted to hospital where safe and appropriate to do so.

Conclusions
The shared outcomes of care between parents and health professionals emphasises the potential merit of adopting a partnership approach in identifying, developing and testing interventions to improve the acceptability, safety, efficiency, and cost-effectiveness of urgent care pathways between home and hospital.

Journal Article Type Article
Acceptance Date Nov 22, 2022
Online Publication Date Dec 16, 2022
Publication Date 2022
Deposit Date Mar 2, 2023
Publicly Available Date Mar 2, 2023
Journal PLOS ONE
Print ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 17
Issue 12
Article Number e0278777
DOI https://doi.org/10.1371/journal.pone.0278777

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