Making the case for paediatric one-day admission in SG

One-day admissions for paediatric patients may offer ways to help prevent hospital congestion, suggests a Singapore study.

“Paediatric one-day admissions present an opportunity to develop and implement interventions targeted at the healthcare system, the emergency department (ED), the paediatric patient, and their caregiver, in order to safely slow down and perhaps reverse the trend of increased hospital admissions,” the researchers said.

This retrospective study involved paediatric patients admitted from a general ED of an adult tertiary hospital to a paediatric tertiary hospital between 1 August 2018 and 30 April 2020. Researchers obtained data in a standardized form and included these in the analysis.

One-day admission was defined as inpatient stay of <24 h from the time of admission to discharge. An unnecessary admission referred to one with no diagnostic test ordered, intravenous medication given, therapeutic procedure done, or specialty review made in the inpatient unit.

A total of 13,944 paediatric attendances were identified, of which 1,160 (8.3 percent) were admitted. Among those who had been admitted, 481 (41.4 percent) were one-day admissions. [Singapore Med J 2025;66:15-19]

The most common conditions of these patients were upper respiratory tract infections (n=62, 12.9 percent) gastroenteritis (n=60, 12.5 percent), and head injury (n=52, 10.8 percent). For ED admissions, the most common reasons were inpatient treatment (n=203, 42.2 percent), inpatient monitoring (n=185, 38.5 percent), and inpatient diagnostic investigations (n=32, 12.3 percent).

Of note, 96 one-day admissions (20.0 percent) were deemed unnecessary.

"The predominantly minor conditions which require no diagnostic test, intravenous medication, therapeutic procedure performed, and specialty review could be better treated with provision of medical care in the community, instead of at the inpatient unit of a hospital,” the researchers said.

Self-referral

Majority of the one-day admissions were self-referral to the ED, with patients and their caregivers presenting to the ED first even for minor injuries instead of consulting the primary care services in outpatient polyclinics and clinics run by private general practitioners.

This predilection for ED visit could be attributed to the perceived severity of the clinical condition by the caregivers, availability of after office hours care, advantage of ED being a one-stop treatment centre with all the necessary facilities, and lack of confidence in nonpaediatric services at managing paediatric conditions. [Singapore Med J 2016;57:314-319; Pediatr Emerg Care 2007;23:532-536]

“While efforts have been made for local expansion and improvements in paediatric care provided by the primary care services within Singapore, this intervention alone might be inadequate to significantly change current health-seeking behaviour—a phenomenon which was noted in Nottingham, where admission rates continued to rise despite the increasing number of better qualified general practitioners and development of community paediatric teams,” the researchers said. [Br Med J 1977;2:1140-1142] 

To reduce the issue of unnecessary paediatric one-day admissions, the researchers recommend scheduling visits at early review clinics or providing consult via telemedicine instead of relying on admission as the only recourse for paediatric patients and their caregivers.

“These follow-up visits after discharge from the ED ensure patient safety through monitoring of disease progression and tailoring of disease management, thus allowing the patient to be cared for in the community and only be referred to hospital for admission when inpatient care is required,” they said. [Healthc Q 2014;17:11-13; Int J Environ Res Public Health 2019;16:2457]