Paediatric short stay unit in a community hospital: effective, efficient and popular.

OBJECTIVES

Short stay medicine is a cost-effective and efficient way to manage patients with suitable conditions. Paediatric acute illness and injury are amenable to short stay medicine. Before January 2004, when Maroondah Hospital recommenced inpatient care for children, 700 children were transferred annually to other hospitals. We describe the implementation and performance of the first paediatric short stay unit (SSU) in Victoria, which was designed to remedy this situation.

METHODS

Set in a 291-bed metropolitan hospital, we audited paediatric emergency attendances, admissions, transfers and discharges. We present quality and consumer satisfaction data.

RESULTS

The environment was designed for the physical, developmental and social needs of children. We implemented education, a system of exclusion criteria and pathways to enhance safety. Over 12 months, of 9097 paediatric attendances, 1101 required inpatient care. Among them, 862 patients were admitted to the SSU and 239 were transferred. Accordingly, 78% of admitted patients were cared for in-house. Median length of stay was 20 h. Of the 708 reviewed cases, there were 19 (3%) unexpected transfers from the SSU, 59 (8%) long stays (>48 h) and no deaths. Via a telephone survey, there were 30/355 (8%) unplanned representations and satisfaction data were overwhelmingly positive. We suggest that this model is suitable for centres with limited paediatric cover. In-house senior emergency physician cover might be preferable to an after-hours junior staff-only model.

CONCLUSION

A co-located paediatric SSU within an ED is an efficient, popular and viable alternative for paediatric services to be delivered in a suburban setting.