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‘Systematic failure’ has led to steep rise in paediatric emergency admissions, study finds

A ‘systematic failure’ by GPs and hospitals has led to a 20% increase in children under five being admitted to hospital for conditions that should be managed in the community over a decade, researchers have claimed.

The UK researchers found an increase each year in emergency admissions in England over the last decade and they concluded that changes to GP responsibility for out-of-hours work and the ‘four-hour wait’ target in A&E may be to blame.

Their report in Archives of Disease in Childhood looked at Hospital Episode Statistics (HES) and Office for National Statistics mid-year population estimates for 739,000 children under 15 admitted to hospital in 2010, up from 594,000 in 1999.

Even when accounting for the surge of births in the UK, there was still a 28% increase in the rate of emergency admissions between 1999 and 2010, with a 24% increase in admissions in those aged between one and four and a 52% increase in admissions in children under 12 months old.

The total number of admissions for primary care sensitive conditions rose by 18%, with a 30% rise in acute conditions (upper and lower respiratory tract infections, gastroenteritis and urinary tract infections), though rates of admission for chronic conditions (asthma, diabetes and epilepsy) fell by 5.6%.

The researchers found that while there was little change in admissions lating between one to two days, there was a twofold increase in admissions lasting less than one day.

The data follow the pattern of rising numbers of preventable emergency admissions, with a recent study showing numbers overall have risen by 40% in a decade despite extra resources being ploughed into programmes aimed at preventing such admissions.

The study’s authors offered many reasons for this increase, including more children being taken to primary care for assessment, and a decrease in the threshold for referral to hospital in primary care. Other reasons include an increase in parents taking their child straight to hospital, and GPs receiving less training in the triaging of children with potentially serious illness.

The study also said the four-hour target in A&E departments had led clinicians to admit rather than observe, and that ‘unintended financial incentives’ created by contacts and payment tarrifs that reward admission could also be a reason for the increase.

The study’s authors concluded: ‘The continuing increase in very-short-term admission of children with common infections suggests a systematic failure, both in primary care (by general practice, out-of-hours care and NHS Direct) and in hospital (by emergency departments and paediatricians), in the assessment of children with acute illness that could be managed in the community.’

The rise may also reflect an increased reluctance by parents and doctors to tolerate uncertainty, they said.

They added: ‘Unplanned hospital admission is costly for the healthcare system and for children, straining finite hospital resources. Once admitted, children are at risk of hospital-acquired infections, medical errors, drug reactions and emotional trauma.’

A reduction in unplanned hospital admissions for children was one of the targets in the 2012/13 NHS Outcomes Framework.


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