Comparative Effectiveness of Direct Admission & Admission Through Emergency Departments for Children

  • STATUS
    Recruiting
  • End date
    Jan 31, 2023
  • participants needed
    1696
  • sponsor
    Dartmouth-Hitchcock Medical Center
Updated on 2 May 2022

Summary

At a national level, emergency departments (EDs) serve as the portal of hospital admission for 75% of hospitalized children. The remainder occur via direct admission, defined as admission to hospital without first receiving care in the hospital's ED. The overall goals of this research are to: (i) implement pediatric direct admission systems at 3 hospitals, (ii) compare the timeliness of healthcare delivery for children who are admitted directly and through emergency departments, (iii) determine which patient populations achieve the greatest benefits from direct admission, and (iv) identify barriers and facilitators of successful implementation.

Description

The Specific Aims of this research are to: (i) Determine the effect of a pediatric direct admission system on timeliness of healthcare provision (the investigator's primary outcome), family experience of care, and rates of clinical deterioration compared to hospital admission beginning in the ED; (ii) Identify the pediatric populations and conditions that experience the greatest benefits from direct admission; and (iii) Through interviews with key informants, identify barriers to and facilitators of implementing standardized direct admission processes.

To achieve these Aims, a stepped-wedge cluster randomized controlled trial at three geographically diverse hospitals in the United States will be conducted, randomizing primary and urgent care practices in the hospitals' catchment area to cross over to the direct admission intervention at four time points. Linear models with random effects for clusters and time period fixed effects will be used to evaluate outcomes associated with the direct admission intervention. To examine for heterogeneity of treatment effects, interactions between direct admission and a priori-specified subgroups will be examined.

Details
Condition Hospitalization, Child Health
Treatment Direct admission, ED admission
Clinical Study IdentifierNCT04192799
SponsorDartmouth-Hitchcock Medical Center
Last Modified on2 May 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Child has one of the following presenting diagnoses
gastroenteritis
dehydration
skin and soft tissue infection
urinary tract infection/pyelonephritis
pneumonia
viral infection not otherwise specified
influenza

Exclusion Criteria

Ineligible children include those
with planned admissions (i.e., chemotherapy)
admitted to non-pediatric hospital medicine services (i.e., intensive care)
transferred from other hospitals
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