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Abstract
Introduction Criteria-led discharges (CLDs) and inpatient care pathways (ICPs) aim to standardise care and improve efficiency by allowing patients to be discharged on fulfilment of discharge criteria. This narrative systematic review aims to summarise the evidence for use of CLDs and discharge criteria in ICPs for paediatric inpatients with asthma, and summarise the evidence for each discharge criterion used.
Methods Database search using keywords was performed using Medline, Embase and PubMed for studies published until 9 June 2022. Inclusion criteria included: paediatric patients <18 years old, admitted to hospital with asthma or wheeze and use of CLD, nurse-led discharge or ICP. Reviewers screened studies, extracted data and assessed study quality using the Quality Assessment with Diverse Studies tool. Results were tabulated. Meta-analysis was not performed due to heterogeneity of study designs and outcomes.
Results Database search identified 2478 studies. 17 studies met the inclusion criteria. Common discharge criteria include bronchodilator frequency, oxygen saturation and respiratory assessment. Discharge criteria definitions varied between studies. Most definitions were associated with improvements in length of stay (LOS) without increasing re-presentation or readmission.
Conclusion CLDs and ICPs in the care of paediatric inpatients with asthma are associated with improvements in LOS without increasing re-presentations or readmissions. Discharge criteria lack consensus and evidence base. Common criteria include bronchodilator frequency, oxygen saturations and respiratory assessment. This study was limited by a paucity of high-quality studies and exclusion of studies not published in English. Further research is necessary to identify optimal definitions for each discharge criterion.
- Child Health
- Health Care Economics and Organizations
- Paediatrics
- Respiratory Medicine
Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.
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Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.
Footnotes
Twitter @Ary89, @DrJoannaL, @DrNedaSo
Contributors AS contributed to the concept and design of the study, the acquisition and analysis of data, the drafting and revision of the manuscript, approval of the final manuscript and agrees to be accountable for all aspects of the work. AS acts as the guarantor for the overall content, conduct of the study and decision to publish. JL contributed to the concept and design of the study, the acquisition and analysis of data and revision of the manuscript. NS contributed to the acquisition and analysis of data. KC conceptualised the study and contributed to its design and revision of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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