Admission patterns of paediatric patients aged 0-4 years diagnosed with respiratory conditions between Emergency Department (ED) and acute paediatrics and its relationship to zero-day admissions.

The number of children presenting to National Health Service (NHS) Emergency Departments (ED) in England is increasing, with a reported 28% increase in presentations in children aged less than 15 years between 1999 and 2010 (Gill et al. 2013). Alongside increased presentation rates, emergency hospital admissions have also increased, with Keeble and Kossarova (2017) reporting a 12% rise between 2005 and 2016, and in particular lasting less than 24-hours, known as zero- day admissions (Gill et al. 2013). Children aged 0-4 years are determined as the most frequently presenting age group at ED (Sands et al. 2011) and a respiratory diagnosis as the second most prevalent condition for this age group (Sands et al. 2011). However, evidence examining why this high conversion rate from presentation to admission exists is scarce. The ability of maintaining such emergency provision is under continuous scrutiny and review. Using a mixed-methodology approach, this work explored common characteristics of the 0-4 year’s patient group who were admitted from ED to acute paediatrics with a respiratory diagnosis. Experiences and knowledge of unplanned admissions from health care professionals working in acute paediatrics were obtained via semi-structured interviews. These findings aided the development of themes which were subsequently converted into quantifiable variables. These variables alongside variables identified through systematic literature review were used to interrogate data of N = 211 children aged 0-4 years old admitted to hospital via the emergency department between March 2017-March 2018 with a respiratory diagnosis. The data was obtained under freedom of information requests, from two district general hospitals in the East Midlands. The minimally used Bayesian method of information analysis (Noyes et al. 2019) was employed to facilitate the synthesis of qualitative and quantitative evidence. This achieved an in depth triangulation of findings and concepts (Dixon-Woods et al. 2005). Overall this work concludes that whilst data analysis in silo did not provide statistical significance of the variables in relation to zero-day admissions, its evaluation in conjunction with the interview transcripts led to a deeper understanding of characteristics contributing to zero-day admissions. This further led to identification of future research of more refined characteristics which will aid in the reduction of short-stay emergency admissions to hospital.