Systematic failures by GPs lead to rise in children admitted to hospital as emergencies
A ‘systematic failure’ by GPs and hospitals has led to a 50 per cent rise in the number of under fives being admitted to wards as emergencies in the last decade.Young children are increasingly being admitted to hospital beds for short periods with conditions that could be treated at home, an Oxford University study has found, as GPs are unable to determine straightforward cases and targets encourage admissions, they said.
The change to the GP contract in 2004 which allowed family doctors to opt out of providing out of hours services ‘may have played an important role’ in the rise, it was argued, along with the four-hour waiting time target that means patients are more likely to be admitted to a bed in order to get them out of A&E.
The study found there has been a steady increase in emergency admissions in children since 2003, despite a drop in child deaths and admissions due to long-term conditions such as asthma and epilepsy.
Common respiratory, urinary tract and gut infections account for much of the rise, it was found.
Admissions of children aged under one rose by 52 per cent up to 2010 and in children aged one to four by a quarter to reach around 500,000 in England by 2010.
Lead author Mr Peter Gill, of the Department of Primary Care Health Services, at University of Oxford, said: “The rise in emergency admission rates for older children has slowed in recent years, but in children under five years it continues to increase at an annual rate of three per cent.
“If the rate continues to increase at three per cent per year, population projections for England suggest that 731000 children aged under five will be admitted as emergencies in 2020, which is 230000 more than are currently admitted.
“The escalating increase after 2003 in very-short-term admission of children with conditions that are usually managed at home suggests an increasing failure of the NHS in assessing and managing children with acute self-limiting illness.”
They authors said the results ‘certainly suggests a reluctance of primary care to observe and manage sick children with self-limiting infections in the community’ and NHS Direct ‘too often’ directed parents to take their child to see the doctor or to hospital.
The way hospitals are set up also plays a part with junior docotrs working in A&E wary of legal action and becoming ‘risk averse’ as a result and short-stay units, fast diagnostics and emergency outpatients centres have meant the threshold for admission has lowered.
The authors concluded: “The continuing increase in very-short-term admission of children with common infections suggests a systematic failure, both in primary care (by general practice, out-of-hours care and NHS Direct) and in hospital (by emergency departments and paediatricians), in the assessment of children with acute illness that could be managed in the community.
“It may also reflect an increased reluctance by parents and doctors to tolerate uncertainty.
“Solving the problem of escalating hospital admissions of children is likely to require restructuring of the way acute paediatric care is delivered, particularly emergency and out-of-hours care.”
The study Increase in emergency admissions to hospital for children aged under 15 in England, 1999–2010 was published online in the Archives of Disease in Childhood.