Background
Methods
Aims
Healthcare setting
Operational definitions
Study design
Admission data
Analysis
Results
Details of SSPAU and zero day admissions
NHS health board | Population of children in 2013 (aged < 15 yearsa) | Area covered by NHS Health board in square miles (children/square mile) | Median deprivation quintile (IQR, 1 = most deprived)) | Median age at admission (SD) | Health board details (number of hospitals with medical paediatric ward, when/if SSPAU opened) | Included in analysis | Details of short stay paediatric assessment units (SSPAU) |
---|---|---|---|---|---|---|---|
NHS Ayrshire and Arran | 58,660 | 1310 (45) | 2 (1,4) | 2.4 (0.8, 7.2) | One medical paediatric ward. SSPAU opened July 2006. | Yes | One hospital, in Kilmarnock where the SSPAU is next to but separate from the inpatient ward. The SSPAU has 10 beds/cots in two cubicles. |
NHS Borders | 17,756 | 1831 (15) | 3 (2,4) | 2.9 (1.0, 8.4) | One medical paediatric ward. SSPAU opened March 2012. | Yes | One hospital, in Melrose. In March 2012, two beds on the paediatric ward were nominated short stay beds. |
NHS Dumfries and Galloway | 22,478 | 2400 (9) | 3 (2,4) | 2.4 (0.9, 6.7) | One medical paediatric ward. SSPAU opened July 2011. | Yes | One hospital, in Dumfries. A 4-bedded short stay unit opened in 2011, as part of the medical ward and was open Mon-Fri 0900–2130 and only received paediatric emergency admission and had no overnight stays. A new hospital opened in 2017 (2 miles from the old hospital site) with a 12-bed SSPAU open Mon-Fri for 24 h and which accepts all medical, surgical, orthopaedic emergency admissions and elective theatre and ambulatory care. |
NHS Fife | 60,109 | 512 (117) | 2 (1,4) | 2.3 (0.8, 6.0) | One medical paediatric ward. SSPAU opened Jan 2011 when the paediatric department moved back to a new building on the original hospital site. To accommodate building, the paediatric department had been relocated for two years to another hospital less than one mile away. | Yes | One hospital, in Kirkcaldy. A general practitioner assessment bay was opened in Jan 2011 and called the SSPAU since November 2017. There are four beds in the unit. |
NHS Forth Valley | 49,594 | 1020 (49) | 3 (2,4) | 2.7 (0.9, 7.0) | One medical paediatric ward. SSPAU opened August 2011 when new hospital opened (on different site to old hospital). | Yes | One hospital, initially in Stirling but moved nine miles to Larbert in 2011. The SSPAU in the new hospital has 8 beds including two three-bedded bays and beds for examining patients. |
NHS Grampian | 91,660 | 3360 (27) | 3 (2,4) | 2.0 (0.7, 5.7) | Two hospitals (65 miles apart) each with a medical paediatric ward. SSPAU opened Jan 2004 when larger of two units moved to new hospital (on the same site as the old hospital). | Yes | Two hospitals, in Aberdeen and Elgin. A SSPAU opened in January 2004 at Royal Aberdeen Children’s Hospital. The unit has five cubicles and two five bedded wards. The unit was part of a new hospital which also opened January 2004. A second smaller unit at Dr. Gray’s Hospital in Elgin does not have an SSPAU |
NHS Greater Glasgow and Clyde | 179,365 | 453 (396) | 2 (1,4) | 1.8 (0.6, 5.1) | Two hospitals (10 miles apart) each with a medical paediatric unit. SSPAU opened in largest unit in 1996–7, and in Nov 2000 in the smaller unit. The larger unit has a paediatric emergency department (ED) and children seen and sent home in the ED are not considered an admission | No (SSPAU opened in larger unit before 2000) | Initially three hospitals, Yorkhill, Paisley and Inverclyde. Royal Glasgow Hospital for Sick Children (Yorkhill). A short stay ward opened in 1996–7, a six bed bay, a four bed bay and four cubicles. Royal Alexandra Hospital (Paisley). An acute assessment unit opened in November 2000. There were 5 beds in a bay and one cublicle. Inverclyde Royal Hospital admitted patients until November 2004, thereafter the inpatient service was centralised to RAH. There was an isolated short stay unit Monday to Friday with no overnight admissions until 2006. |
NHS Highland | 50,588 | 12,507 (4) | 3 (2,4) | 2.3 (0.8, 6.6) | One medical paediatric ward. SSPAU opened May 2016. | No (SSPAU opened after 2013) | One hospital, in Inverness. A five-bedded SSPAU opened in May 2016, next to the paediatric medical ward. |
NHS Lanarkshire | 111,306 | 883 (126) | 2 (1,4) | 2.3 (0.8, 6.7) | One medical paediatric ward. SSPAU opened Feb 2005. | Yes | |
NHS Lothian | 135,517 | 700 (194) | 3 (2,4) | 1.8 (0.6, 4.9) | Two hospitals (17 miles apart) each with a medical paediatric ward. SSPAU opened 2005 in smaller of two units only. The larger unit has a paediatric emergency department (ED) and children seen and sent home in the ED are not considered an admission. | No (SSPAU not opened in larger unit) | Two hospitals, one in Edinburgh and one in Livingstone. The hospital in Edinburgh (the larger of the two) has no SSPAU. The hospital in Livingstone opened a Paediatric Assessment Unit in 2005, a 6 bedded bay on the paediatric medical ward. |
NHS Tayside | 63,309 | 2986 (21) | 3 (2,4) | 2.8 (1.0, 7.4) | Two hospitals (22 miles apart) each with a medical paediatric ward. SSPAU opened 1997 in larger units and May 2004 in smaller unit when it moved to closing overnight. | No (SSPAU opened in larger unit before 2000) | Two hospitals, in Dundee and Perth. Ninewells hospital (Dundee). A paediatric assessment area was set up in late 1997, initially a bay in the ward then with a move to a new building in 2002 the unit was a separate area adjacent to the paediatric inpatient unit Perth Royal Infirmary (Perth). Inpatient services moved to Dundee in 2005 and an ambulatory care unit was maintained in Perth (open Mon-Fri 10 am-6 pm) where children with acute illnesses can be assessed. |
Overall | 3 (2,4) | 2.3 (0.75, 6.25) | Data from 7 of 11 units included |
NHS health board | Number of admissions 2000–2013 | Number of zero day admissions (% of all admissions) | Annual prevalence of zero day admissions/1000 children | Number (% of zero day) admissions | Change in % zero day admission per month (Spearman rho) | SSPAU opened 2000–13 | |
---|---|---|---|---|---|---|---|
Jan 2000 | Jan 2013 | ||||||
NHS Ayrshire and Arran | 57,716 | 26,010 (45%) | 37/1000 | 38 (16.1%) | 428 (53.9%) | 0.86 (p < 0.001) | Yes |
NHS Borders | 15,097 | 5138 (34%) | 24/1000 | 17 (26.2%) | 68 (66.7%) | 0.61 (p < 0.001) | Yes |
NHS Dumfries and Galloway | 16,388 | 4532 (28%) | 17/1000 | 6 (7.4%) | 39 (35.1%) | 0.77 (p < 0.001) | Yes |
NHS Fife | 34,462 | 13,683 (40%) | 19/1000 | 71 (42.0%) | 107 (13.3%) | −0.78 (p < 0.001) | Yes |
NHS Forth Valley | 42,361 | 17,855 (42%) | 30/1000 | 43 (29.1%) | 139 (46.1%) | 0.39 (p < 0.001) | Yes |
NHS Grampian | 59,524 | 17,161 (29%) | 17/1000 | 28 (11.9%) | 108 (43.2%) | 0.96 (p < 0.001) | Yes |
NHS Greater Glasgow and Clyde | 90,863 | 32,648 (36%) | 15/1000 | 109 (20.7%) | 71(34.7%) | 0.73 (p < 0.001) | No (opened pre 2000) |
NHS Highland | 26,058 | 7530 (29%) | 12/1000 | 22 (18.0%) | 71 (39.9%) | 0.71 (p < 0.001) | No |
NHS Lanarkshire | 77,373 | 38,608 (50%) | 28/10000 | 31 (14.5%) | 287 (57.3%) | 0.56 (p < 0.001) | Yes |
NHS Lothian | 75,774 | 22,436 (30%) | 14/10000 | 48 (14.5%) | 168 (36.8%) | 0.60 (p < 0.001) | No |
NHS Tayside | 73,482 | 34,665 (47%) | 46/10000 | 116 (38.7%) | 226 (54.5%) | 0.73 (p < 0.001) | No |
Overall | 569, 098 | 220,517 (39%) | 22/10000 | 529 (21.8%) | 1479 (45.9%) | 0.89 (p < 0.001) |
Total admissions 2000–2013 | Admissions before SSPAU opened | Admissions after SSPAU opened | Percentage of zero day admissions | Relative increase in the proportion of zero day admissions after SSPAU opened | |||||
---|---|---|---|---|---|---|---|---|---|
all | zero | all | zero | all | zero | Before SSPAU opened | After SSPAU opened | ||
All seven health boards | 302,921 | 122,987 | 148,017 | 52,728 | 154,904 | 70,259 | 35.6 | 45.4 | 27.5 |
NHS Ayrshire and Arran | 57,716 | 26,010 | 20,544 | 5644 | 37,172 | 20,366 | 27.5 | 54.8 | 99.3 |
NHS Borders | 15,097 | 5138 | 12,280 | 3708 | 2817 | 1430 | 30.2 | 50.8 | 68.2 |
NHS Dumfries and Galloway | 16,388 | 4532 | 12,718 | 3194 | 3670 | 1338 | 25.1 | 36.5 | 45.4 |
NHS Fife | 34,462 | 13,683 | 29,782 | 12,788 | 4680 | 895 | 42.9 | 19.1 | −55.5 |
NHS Forth Valley | 42,361 | 17,855 | 35,710 | 15,110 | 6651 | 2745 | 42.3 | 41.3 | −2.4 |
NHS Grampian | 59,524 | 17,161 | 13,686 | 2084 | 45,838 | 15,077 | 15.2 | 32.9 | 116 |
NHS Lanarkshire | 77,373 | 38,608 | 23,297 | 10,200 | 54,076 | 28,408 | 43.8 | 52.5 | 19.9 |
Relationship between SSPAU opening and proportion of zero day admissions
All health boards combined
Step change in percentage of zero day admissions relative to all admissions after SSPAU opened | Percentage change in zero day admissions per month between Jan 2000 and Dec 2013 | Change in zero day admission after SSPAU open (Interaction term) (p-value) | |
---|---|---|---|
All centres combined | + 13 [10, 15] | + 0.12 [0.11, 0.14] | p < 0.001 |
NHS Ayrshire and Arran | + 71 [57, 86] | + 0.18 [0.11, 0.26] | p < 0.001 |
NHS Borders | + 14 [2, 27] | + 0.53 [0.42, 0.64] | p = 0.398 |
NHS Dumfries and Galloway | −2 [−12, + 8] | + 0.54 [0.44, 0.64] | p = 0.029 |
NHS Fife | −42 [−49, −36] | −0.29 [−0.37, −0.20] | p = 0.400 |
NHS Forth Valley | − 23 [− 27, 19] | + 0.31 [0.27, 0.35] | p = 0.123 |
NHS Grampian | + 24 [15, 32] | + 0.63 [0.57, 0.69] | p = 0.325 |
NHS Lanarkshire | + 6 [−1, + 15] | + 0.15 [0.08, 0.22] | p < 0.001 |