Sunday, 7 July 2013

Challenging the paediatric ward discharge status-quo

One of the unwritten rules of paediatric medicine is that once a child is admitted to a ward they will stay over-night; and if they are ok they will bed and breakfast and probably go home the next morning.  That is one of the reasons that assessment and observation units were set up.  A recent paper in JAMA Pediatrics by Stephanie Iantorno and Evan Fieldston challenges this assumption, and in particular the idea that morning discharges are necessarily a measure of good practice.  One quote in particular seemed pertinent..."accommodating evening discharges can enhance the patient centeredness of care; families have obligations and barriers, including employment and transportation, that make morning discharges difficult and undesirable."

This seems to be one of the biggest challenges for health systems around the world - not just providing high quality care; but also care that fits in with today's lifestyles and expectations that things should happen when we want them to happen or when we need them to happen.  This is an American paper, and of course the health system there is very different to the UK; but the same challenges exist.  Some of this can be seen in the case of general practice hours - which often don't fit in with the hours of those who work in the day.  Another surprisingly important issue in London is avoiding the rush-hour; 07.00-10.00 and 16.00-19.00 are not good discharge times, particularly if one is relying on public transport!

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