Abstract：
Paediatric attendances at the emergency department (ED) are often admitted to the hospital less than 24 h to allow time for more extended evaluation. Innovative organisational models could prevent these hospital admissions without compromising safety or quality of delivered care. Therefore, this systematic review identifies evidence on organisational models at the ED with the primary aim to reduce hospital admissions among paediatric patients. Following the PRISMA guidelines, three bibliographic databases (Ovid Medline, Embase, and Cochrane Library) were searched. Studies on organisational models in Western countries, published between January 2009 and January 2021, which applied a comparative design or review and studied at least hospital admission rates, were included. Analyses were mainly descriptive because of the high heterogeneity among included publications. The primary outcome is hospital admission rates. Secondary outcomes are ED length of stay (LOS), waiting time, and patient satisfaction. Sixteen publications described several innovative organisational models ranging from the creation of dedicated units for paediatric patients, innovative staffing models to bringing paediatric critical care physicians to patients at rural EDs. However, the effect on hospital admission rates and other outcomes are inconclusive, and some organisational models may improve certain outcomes in certain settings or vice versa. It appears that a paediatric consultation liaison team has the most consistent effect on hospital admission rates and LOS of paediatric patients presenting with mental problems at the ED. Implementing new innovative organisational models at the ED for paediatric patients could be worthwhile to decrease hospital admissions. However, the existing evidence is of rather weak quality. Future service developments should, therefore, be conducted in a way that allows objective evaluation.
摘要：
急诊科（ED）的儿科就诊通常不到24小时就可以住院，以便有时间进行更长时间的评估。创新的组织模式可以防止这些入院，而不会影响所提供护理的安全性或质量。因此,本系统综述确定了ED组织模式的证据,主要目的是减少儿科患者的住院率.按照PRISMA准则，三个书目数据库(OvidMedline，Embase,和Cochrane图书馆）进行了搜索。西方国家的组织模式研究，在2009年1月至2021年1月之间发布，其中应用了比较设计或审查，并至少研究了住院率，包括在内。分析主要是描述性的，因为纳入的出版物之间存在高度异质性。主要结果是住院率。次要结果是ED住院时间（LOS），等待时间,患者满意度。16种出版物描述了几种创新的组织模式，包括为儿科患者创建专用单元，创新的人员配备模式，为农村ED的患者带来儿科重症监护医生。然而,对入院率和其他结果的影响尚无定论，某些组织模式可能会在某些环境中改善某些结果，反之亦然。看来，儿科咨询联络小组对在ED出现精神问题的儿科患者的入院率和LOS影响最一致。在ED为儿科患者实施新的创新组织模式可能值得减少住院人数。然而,现有的证据质量相当薄弱。未来的服务发展应该，因此,以允许客观评估的方式进行。
