title: Direct Admission to Hospital: A Mixed Methods Survey of Pediatric Practices, Benefits, and Challenges.
abstract: BACKGROUND
  Direct admissions account for 25% of pediatric unscheduled hospitalizations. Despite this, our knowledge of direct admission practices and safety is limited. This study aimed to characterize direct admission practices, benefits, and challenges at a diverse sample of hospitals and to identify diagnoses most appropriate for this admission approach.
  
  
  METHODS
  We conducted a national survey at a stratified random sample of 177 US hospitals using both closed and open-ended questions. Descriptive statistics were calculated to summarize numeric responses, while qualitative content analysis was performed to identify emergent themes.
  
  
  RESULTS
  Responses were received from 108 hospitals (61%). Hospitals represented all geographic regions and employed varied emergency medicine and inpatient care models. One hundred three respondents (95%) reported that their hospitals accepted direct admissions, and 45 (50%) expressed the view that more children should be admitted directly. Perceived benefits included the following: improved efficiency; patient and physician satisfaction; earlier access to pediatric-specific care; continuity of care; and reduced risk of nosocomial infection. Risks and challenges included the following: difficulties determining admission appropriateness; inconsistent processes; provision of timely care; and patient safety. Populations and diagnoses reported as most appropriate and inappropriate for direct admission varied considerably across respondents.
  
  
  CONCLUSIONS
  While respondents described benefits of direct admission for both patients and health care systems, many also reported challenges and safety concerns. Our results may inform subsequent epidemiologic and patient-centered outcomes research to evaluate the safety and effectiveness of direct admissions.
authors: Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts Medical Center, Boston, Mass; Tufts University School of Medicine, Boston, Mass. Electronic address: jleyenaar@post.harvard.edu.
authors: JoAnna K
authors: JK
authors: Leyenaar
authors: Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts Medical Center, Boston, Mass.
authors: Emily R
authors: ER
authors: O'Brien
authors: Tufts University School of Medicine, Boston, Mass.
authors: Natasha
authors: N
authors: Malkani
authors: Tufts University School of Medicine, Boston, Mass; Center for Quality of Care Research, Baystate Medical Center, Springfield, Mass.
authors: Tara
authors: T
authors: Lagu
authors: Tufts University School of Medicine, Boston, Mass; Center for Quality of Care Research, Baystate Medical Center, Springfield, Mass.
authors: Peter K
authors: PK
authors: Lindenauer
mesh_terms: D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care; D003428:Cross Infection; D006297:Health Services Accessibility; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D061214:Patient Safety; D017060:Patient Satisfaction; D010372:Pediatrics; D011795:Surveys and Questionnaires; D014481:United States
keywords: child; direct admission; emergency room volume; health resources/utilization; hospital medicine; patient admission; pediatrics