SG sees rise in 1-day paediatric admissions

A recent study from Singapore reports that paediatric 1-day admissions made up about 2/5 of all admissions from the general emergency department (ED) to a paediatric hospital.

According to the researchers, most of the conditions were easy to diagnose, manage, and treat, and when they evaluated the need for admission based on the use of hospital resources – defined as the need for diagnostic test, IV medication, therapeutic procedure, and specialty review – about a fifth were considered unnecessary. [Singapore Med J 2025;66:15-19]

“Overall, 20 percent of 1-day admissions were unnecessary, as there was no diagnostic test ordered, IV medication administered, therapeutic procedure performed, or specialty review made in the inpatient unit,” they said.

Driving factors

Over 90 percent of the admissions were self‑referrals – instead of opting for primary care services via outpatient polyclinics and private GP clinics, the patients and their caregivers presented to the ED first, even for minor conditions, the investigators noted.

“This health‑seeking behaviour with a 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 non‑paediatric services at managing paediatric conditions,” they explained.

Nearly three‑quarters of the admissions occurred after office hours. These visits may have been driven by the difficulty of bringing the child during office hours due to work commitments. Caregivers may also opt for admission if they saw no significant improvement in the child following the after-office-hours visit, and they are not confident enough to manage the child’s condition at home. [Emerg Med J 2019;36:39‑46]

“[The] change in characteristics of hospital admission can cause undesirable outcomes. It disrupts family life, causes emotional distress, and increases the risk of contracting nosocomial infections,” the researchers said.

High inpatient admission rate also strains hospital resources and increases healthcare costs. “Thus, there is a need to minimize such admissions from the ED, which may not have been necessary,” they added.

Reversing the trend

“Paediatric 1-day admissions present an opportunity to develop and implement interventions targeted at the healthcare system, the ED, the patient, and the caregiver, to safely slow down and perhaps reverse the trend of increased hospital admissions,” the researchers said.

The investigators recommended the implementation of observation protocols in short-stay units at the ED. [Arch Dis Child 2005;90:138-142] Evidence shows that short-stay units are effective in preventing admissions, especially those that are unnecessary, without compromising healthcare delivery standards. [Arch Dis Child 2012;97:304‑311; Arch Paediatr 2001;8:1062‑1070; Paediatr Emerg Care 2000;16:223‑229]

“Instead of relying on admission as the only safety net for paediatric patients and their caregivers, scheduling visits at early review clinics or providing consult via telemedicine also holds great potential in mitigating the issue of unnecessary paediatric 1-day admissions,” they added.

Follow‑up visits following ED discharge ensure patient safety by monitoring disease progression and tailoring management, thereby allowing the patient to receive care from the community and only opting for hospital re-admission when inpatient care is warranted. [Healthc Q 2014;17:11‑13; Int J Environ Res Public Health 2019;16:2457]

Study characteristics

There were 13,944 paediatric attendances at the general ED. Of the 1,161 (8.3 percent) patients admitted, 481 (41.4 percent) were 1-day admissions.

The most common diagnoses were upper respiratory tract infection (12.9 percent), gastroenteritis (12.5 percent), and head injury (10.8 percent). The most common reasons for ED admissions were inpatient treatment (42.2 percent), monitoring (38.5 percent), and diagnostic investigations (12.3 percent). Two of the admissions were for social reasons (lack of caregiver at home and lack of parental confidence to care for the sick child at home).