TAMPA, FLA. — Anywhere from 12% to 45% of hospital admissions of children for dehydration could be prevented, according to results from a study of 85 such admissions.
Dr. Vineeta Mittal and Dr. Glenn Flores of the University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, performed a cross-sectional survey of parents, primary care providers, and inpatient attending physicians involved in care of pediatric patients admitted for dehydration. The study included patients admitted to an urban hospital over a 20-month period. The study, part of a larger study of 560 children admitted for avoidable hospitalization conditions, was presented in a poster at a pediatric hospital medicine meeting.
The researchers asked each patient's parent or guardian these questions:
▸ Could hospitalization have been prevented? If so, how?
▸ Did the parent speak to the primary care provider, or take the child to visit a primary care provider, prior to admission?
▸ Did the family have good access to care, or were there financial barriers or difficulties in obtaining medication?
▸ Was the parent satisfied with the child's regular provider (if there was one)?
The investigators also asked the primary care physician and the inpatient attending physician for each patient if and how the hospitalization could have been avoided.
The researchers found that, depending on who did the assessment, 12%-45% of hospitalizations for dehydration could have been avoided. Many of the admissions could have been prevented if parents had had better information about their child's condition and about the proper use of oral rehydration solution therapy, they said.
Overall, all three sources—parents, the primary care physician, and the inpatient attending physician—assessed a particular hospitalization as being avoidable 12% of the time, and any one of the three sources said it was avoidable 45% of the time. When it was broken down by who did the assessment, parents said the hospitalization could have been avoided 25% of the time, compared with 33% of the time for primary care providers and 19% of the time for the inpatient attending physicians.
In one case cited by the researchers, the parent said the hospitalization could have been avoided “if they had explained it to me better in the [primary care] clinic,” the primary care physician said it could have been avoided “with more appropriate care,” and the inpatient attending physician said it could not have been avoided because it was a “rapid onset, too severe.”
In general, “pediatricians need to provide more in-depth education to parents about how to keep children hydrated,” Dr. Mittal said in an interview. “Even reinforcing that as little as 1 teaspoon [of fluid] every 10 minutes is okay may help reduce emergency department visits and hospitalizations.”
Also, having a short-stay unit at the hospital would help, she said. “A lot of these kids don't need to be in the hospital and stay there for days.” Just getting them rehydrated and watching them for a few hours before sending them home would probably be enough in many cases.
Another big barrier to preventing a hospital admission was a lack of health insurance. “If the parents had had insurance, they would have gone to or called their primary care physician for advice,” Dr. Mittal said.
She declared no conflicts of interest.
A related video with Dr. Mittal is at www.youtube.com/HospitalistNews
Many of the admissions could have been prevented if parents had had better information.
Source DR. MITTAL