A systematic review of interventions to reduce hospital stay and readmissions in the paediatric population

Introduction. This systemic review describes interventions designed to shorten length of stay (LOS) in hospital or the Emergency Department (ED).
Methods. Papers published from 2000 until February 2024 were sought in MEDLINE, EMBASE, Psych INFO, SCIE, Cochrane Library Database and DARE databases. Outcomes were LOS, readmissions, and healthcare cost.
Results. Eighteen studies were eligible, including 10 RCTs and eight non-randomised studies. Children were recruited from ED in seven studies and from the paediatric ward in 11 studies. Nine studies delivered Out-Patient Parenteral Antibiotic Therapy (OPAT) to children and were associated with reduced LOS and cost but longer duration of antibiotic treatment. Seven studies described “hospital at home” in children admitted with a range of conditions and some reported reduced readmissions and length of stay in addition to reduced costs, compared to standard hospital care. Two studies provided care in a step-down facility, and reported reduced readmissions and costs. Conclusions. Many of the interventions identified were cost effective but often led to a longer total period of care compared to inpatient care. Providing care outside of hospital is not associated with increased adverse outcomes compared to receiving care in hospital and brings benefit to the child’s family.