Hopper Sandy M, Archer Peter, Breene Richard, Bolt Penny, Sammartino Luke
Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
Emerg Med Australas. 2008 Oct;20(5):431-6. doi: 10.1111/j.1742-6723.2008.01112.x.
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.
Set in a 291-bed metropolitan hospital, we audited paediatric emergency attendances, admissions, transfers and discharges. We present quality and consumer satisfaction data.
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.
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.
短期住院治疗是管理适合相应病情患者的一种经济高效的方式。儿科急性疾病和损伤适合采用短期住院治疗。在2004年1月马鲁当医院重新开始为儿童提供住院护理之前，每年有700名儿童被转至其他医院。我们描述了维多利亚州首个儿科短期住院病房（SSU）的实施情况及成效，该病房旨在改善这一状况。
在一家拥有291张床位的大都市医院里，我们对儿科急诊就诊、入院、转院及出院情况进行了审核。我们呈现了质量和患者满意度数据。
该环境是根据儿童的身体、发育及社交需求设计的。我们开展了教育活动，实施了排除标准体系及相关途径以提高安全性。在12个月期间，9097例儿科就诊病例中，1101例需要住院护理。其中，862例患者入住了短期住院病房，239例被转院。相应地，78%的入院患者在本院得到了护理。中位住院时长为20小时。在708例被审查病例中，有19例（3%）意外从短期住院病房转出，59例（8%）住院时间过长（>48小时），且无死亡病例。通过电话调查，有30/355例（8%）非计划复诊，且满意度数据总体呈积极态势。我们认为这种模式适用于儿科服务覆盖有限的中心。本院配备高级急诊医师可能比仅在非工作时间配备初级工作人员的模式更可取。
在急诊科内设置的儿科短期住院病房是在郊区环境中提供儿科服务的一种高效、受欢迎且可行的替代方案。
