Assessing the appropriateness of paediatric hospital admissions in the United Kingdom

Background. In order to assess whether the documented rise in paediatric admissions was due to inappropriate admissions, an objective measure of the appropriateness of paediatric admissions, modified for use in the United Kingdom, was used to measure the level of inappropriate admissions. The relationship of appropriateness of admissions to age, gender, time of admission and source of referral was investigated. Methods. A retrospective review was carried out of a sample of paediatric records in 13 NHS district general hospitals in South Eastern England between April 1990 and March 1991 using the Paediatric Appropriateness Evaluation Protocol (PAEP) modified for use in the United Kingdom. Results. A total of 3324 paediatric admissions in 13 hospitals were assessed. Eight per cent of the sampled admissions were inappropriate. Age [odds ratio (OR) = 0.87], gender (OR = 1.39) and weekend admissions (OR = 1.42) were associated with inappropriate admissions. After controlling for these factors, there was no significant variation between hospitals. Conclusion. The low level of inappropriate admissions may be a reflection of well-developed primary care services in the United Kingdom. Alternatives to hospital admission for the assessment of minor self-limiting illness in young children may have a role in reducing inappropriate admissions.