Interventions in primary and community care to reduce urgent paediatric hospital admissions: systematic review

Background: There has been a rise in urgent paediatric hospital admissions and interventions to address this are required.

Objective: To systemically review the literature describing community (or non-hospital)-based interventions designed to reduce emergency department (ED) visits or urgent hospital admissions.

Data sources: MEDLINE, Embase, OVIS SP, PsycINFO, Science Citation Index Expanded/ISI Web of Science (1981-present), the Cochrane Library database and the Database of Abstracts of Reviews of Effectiveness.

Study eligibility criteria: Randomised controlled trials (RCTs) and before-and-after studies.

Participants: Individuals aged <16 years.

Study appraisal and synthesis methods: Papers were independently reviewed by two researchers. Data extraction and the Critical Appraisals Skills Programme checklist was completed (for risk of bias assessment).

Results: Seven studies were identified. Three studies were RCTs, three were a comparison between non-randomised groups and one was a before-and-after study. Interventions were reconfiguration of staff roles (two papers), telemedicine (three papers), pathways of urgent care (one paper) and point-of-care testing (one paper). Reconfiguration of staff roles resulted in reduction in ED visits in one study (with a commensurate increase in general practitioner visits) but increased hospital admissions from ED in a second. Telemedicine was associated with a reduction in children's admissions in one study and reduced ED admissions in two further studies. Interventions with pathways of care and point-of-care testing did not impact either ED visits or urgent admissions.

Conclusions and implications: New out-of-hospital models of urgent care for children need to be introduced and evaluated without delay.

Prospero registration number: CRD42021274374.