Direct Admission to Hospital: A Mixed Methods Survey of Pediatric Practices, Benefits, and Challenges.

BACKGROUND: Direct admissions account for 25% of pediatric unscheduled hospitalizations. Despite this, our knowledge of direct admission practices and safety is limited. This study aimed to characterize direct admission practices, benefits, and challenges at a diverse sample of hospitals and to identify diagnoses most appropriate for this admission approach.
METHODS: We conducted a national survey at a stratified random sample of 177 US hospitals using both closed and open-ended questions. Descriptive statistics were calculated to summarize numeric responses, while qualitative content analysis was performed to identify emergent themes.
RESULTS: Responses were received from 108 hospitals (61%). Hospitals represented all geographic regions and employed varied emergency medicine and inpatient care models. One hundred three respondents (95%) reported that their hospitals accepted direct admissions, and 45 (50%) expressed the view that more children should be admitted directly. Perceived benefits included the following: improved efficiency; patient and physician satisfaction; earlier access to pediatric-specific care; continuity of care; and reduced risk of nosocomial infection. Risks and challenges included the following: difficulties determining admission appropriateness; inconsistent processes; provision of timely care; and patient safety. Populations and diagnoses reported as most appropriate and inappropriate for direct admission varied considerably across respondents.
CONCLUSIONS: While respondents described benefits of direct admission for both patients and health care systems, many also reported challenges and safety concerns. Our results may inform subsequent epidemiologic and patient-centered outcomes research to evaluate the safety and effectiveness of direct admissions.