TY - JOUR

T1 - Short-stay urgent hospital admissions of children with convulsions

T2 - A mixed methods exploratory study to inform out of hospital care pathways

AU - Malcolm, Cari

AU - Hoddinott, Pat

AU - King, Emma

AU - Dick, Smita

AU - Kyle, Richard

AU - Wilson, Philip

AU - France, Emma

AU - Aucott, Lorna

AU - Turner, Stephen W.

N1 - Publisher Copyright: © 2024 Malcolm et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2024

Y1 - 2024

N2 - Objective To inform interventions focused on safely reducing urgent paediatric short stay admissions (SSAs) for convulsions. Methods Routinely acquired administrative data from hospital admissions in Scotland between 2015- 2017 investigated characteristics of unscheduled SSAs (an urgent admission where admission and discharge occur on the same day) for a diagnosis of febrile and/or afebrile convulsions. Semi-structured interviews to explore perspectives of health professionals (n = 19) making referral or admission decisions about convulsions were undertaken. Interpretation of mixed methods findings was complemented by interviews with four parents with experience of unscheduled SSAs of children with convulsion. Results Most SSAs for convulsions present initially at hospital emergency departments (ED). In a subset of 10,588 (11%) of all cause SSAs with linked general practice data available, 72 (37%) children with a convulsion contacted both the GP and ED pre-admission. Within 30 days of discharge, 10% (n = 141) of children admitted with afebrile convulsions had been readmitted to hospital with a further convulsion. Interview data suggest that panic and anxiety, through fear that the situation is life threatening, was a primary factor driving hospital attendance and admission. Lengthy waits to speak to appropriate professionals exacerbate parental anxiety and can trigger direct attendance at ED, whereas some children with complex needs had direct access to convulsion professionals. Conclusions SSAs for convulsions are different to SSAs for other conditions and our findings could inform new efficient convulsion-specific pre and post hospital pathways designed to improve family experiences and reduce admissions and readmissions.

AB - Objective To inform interventions focused on safely reducing urgent paediatric short stay admissions (SSAs) for convulsions. Methods Routinely acquired administrative data from hospital admissions in Scotland between 2015- 2017 investigated characteristics of unscheduled SSAs (an urgent admission where admission and discharge occur on the same day) for a diagnosis of febrile and/or afebrile convulsions. Semi-structured interviews to explore perspectives of health professionals (n = 19) making referral or admission decisions about convulsions were undertaken. Interpretation of mixed methods findings was complemented by interviews with four parents with experience of unscheduled SSAs of children with convulsion. Results Most SSAs for convulsions present initially at hospital emergency departments (ED). In a subset of 10,588 (11%) of all cause SSAs with linked general practice data available, 72 (37%) children with a convulsion contacted both the GP and ED pre-admission. Within 30 days of discharge, 10% (n = 141) of children admitted with afebrile convulsions had been readmitted to hospital with a further convulsion. Interview data suggest that panic and anxiety, through fear that the situation is life threatening, was a primary factor driving hospital attendance and admission. Lengthy waits to speak to appropriate professionals exacerbate parental anxiety and can trigger direct attendance at ED, whereas some children with complex needs had direct access to convulsion professionals. Conclusions SSAs for convulsions are different to SSAs for other conditions and our findings could inform new efficient convulsion-specific pre and post hospital pathways designed to improve family experiences and reduce admissions and readmissions.

U2 - 10.1371/journal.pone.0301071

DO - 10.1371/journal.pone.0301071

M3 - Journal article

C2 - 38557817

AN - SCOPUS:85189137387

VL - 19

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 4 APRIL

M1 - e0301071

ER -