Reducing overnight hospital admissions: an audit and literature review

This paper presents the findings of an audit of children staying overnight in a District General Hospital, and examines them in the light of current research. The aim was to establish whether it was possible to reduce overnight stays by identifying the characteristics of the children, and their patterns of medical attention and nursing intervention. An audit of 45 sets of case notes was undertaken by a single investigator. The findings indicated that the majority of children were under three years, and were more likely to attend after mid-day. Initial medical assessment and treatment tended to be by a junior doctor and discharge was more likely to be by a consultant. The number of nursing interventions ranged between two and eight, with 90% (n=45) of the sample receiving five or less. Some inconsistencies were noted between the audit findings and current research, for example in relation to admitting doctor. However, both the audit and related research indicate that overnight stays could be reduced if children are reviewed more frequently, and particularly in the late evening, by a consultant. Neither the audit nor related research identified predictors of which children were likely to stay only one night. The characteristics of the child, including age and medical diagnosis, were not found to be predictors of which children were likely to stay only one night, and which were likely to become more seriously ill. In addition, non-medical factors, such as social circumstances, do not appear to be predictors of length of stay. Recommendations for practice include the establishment of a 24–hour assessment unit for children, and consultant attendance in the late evening. Further research is needed into the precise nature and number of nursing interventions needed by children, and whether these could be delivered at home. Finally, a model for prediction of length of stay needs to be developed.