Background Hospital admission, like hospital discharge, represents a transition of care associated with changes in setting, healthcare providers and clinical management. While considerable efforts have focused on improving the quality and safety of hospital-to-home transitions, there has been little focus on transitions into hospital.
Objectives Among children hospitalised with ambulatory care sensitive conditions, we aimed to characterise families’ experiences as they transitioned from outpatient to inpatient care, identify hospital admission processes and outcomes most important to families and determine how parental perspectives differed between children admitted directly and through emergency departments (ED).
Methods We conducted semistructured interviews with parents of hospitalised children at four structurally diverse hospitals. We inquired about preadmission healthcare encounters, how hospital admission decisions were made and parents’ preferences regarding hospital admission processes and outcomes. Interviews were transcribed verbatim and analysed using a general inductive approach.
Results We conducted 48 interviews. Participants were predominantly mothers (74%); 45% had children with chronic illnesses and 52% were admitted directly. Children had a median of two (IQR 1–3) healthcare encounters in the week preceding hospital admission, with 44% seeking care in multiple settings. Patterns of healthcare utilisation were influenced by (1) disease acuity and healthcare access; (2) past experiences; and (3) varied perspectives about primary care and ED roles as hospital gatekeepers. Participants’ hospital admission priorities included: (1) effective clinical care; (2) efficient admission processes; (3) safety and security; (4) timeliness; and (5) patient and family-centred processes of care.
Conclusions Families received preadmission care in several settings and described varying degrees of care coordination during their admission processes. This research can guide improvements in hospitals’ admission systems, necessary to achieve health system integration and continuity of care.
- qualitative research
- prehospital care
- patient-centred care
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Contributors JKL conceptualised and designed the study, analysed the results, drafted the initial manuscript and approved the final manuscript as submitted. PAR conducted the interviews, analysed the results, reviewed and revised the manuscript, and approved the final manuscript as submitted. ERO analysed the results, reviewed and revised the manuscript, and approved the final manuscript as submitted. PKL contributed to study design and analysis of results, reviewed and revised the manuscript, and approved the final manuscript as submitted.
Funding National Heart, Lung, and Blood Institute (K24HL132008); Agency for Healthcare Research and Quality (K08HS024133); National Center for Advancing Translational Sciences, National Institutes of Health (UL1 TR001064).
Competing interests None declared.
Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Ethics approval Tufts Medical Center, Boston, MA; Boston Children’s Hospital, Boston, MA; Lowell General Hospital, Lowell, MA; and Brockton General Hospital, Brockton, MA.
Provenance and peer review Not commissioned; externally peer reviewed.