A systematic review of the organizational, environmental, professional and child and family factors influencing the timing of admission to hospital for children with serious infectious illness

BERNIE CARTER, Damian Roland, LUCY BRAY, Jane Harris, Poornima Pandey, Jo Fox, Enitan Carrol, Sarah Neill

Research output: Contribution to journalArticle

Abstract

Background: Infection, particularly in the first 5 years of life, is a major cause of
childhood deaths globally, many deaths from infections such as pneumonia and
meningococcal disease are avoidable, if treated in time. Some factors that contribute to morbidity and mortality can be modified. These include organisational and environmental factors as well as those related to the child, family or professional.

Objective: Examine what organizational and environmental factors and individual
child, family and professional factors affect timing of admission to hospital for children with a serious infectious illness.

Design: Systematic review.

Data sources: Key search terms were identified and used to search CINAHL Plus,
Medline, ASSIA, Web of Science, The Cochrane Library, Joanna Briggs Institute
Database of Systematic Review.

Study appraisal methods: Primary research and literature reviews were included if participants included or were restricted to children under 5 years of age with serious infectious illnesses, included parents and/or first contact health care professionals in primary care, urgent and emergency care and where the research had been conducted in OECD high income countries. The Mixed Methods Appraisal Tool was used to review the methodological quality of the studies.

Main findings: From a preliminary pool of 65 screened papers, 35 papers were
selected for full review, 12 studies fitted the inclusion criteria. Factors influencing the timing of admission to hospital included the variability in children’s illness trajectories and pathways to hospital, parental recognition of symptoms and clinicians nonrecognition of illness severity, parental help-seeking behaviour and clinician responses, access to services, use and non-use of ‘gut feeling’ by clinicians, and sub-optimal management within primary, secondary and tertiary services.

Conclusions: The pathways taken by children with a serious infectious illness to
hospital are complex and influenced by a variety of potentially modifiable individual, organisational, environmental and contextual factors. Supportive, accessible, respectful services that provide continuity, clear communication, advice and safety-netting are important as is improved training for clinicians and a mandate to attend to ‘gut feeling’.

Implications: Relatively simple interventions such as improved communication have the potential to improve the quality of care and reduce morbidity and mortality in children with a serious infectious illness
Original languageEnglish
JournalPLoS ONE
Publication statusAccepted/In press - 29 Jun 2020

Keywords

  • serious infectious illness
  • factors
  • timing
  • admission
  • gut feeling
  • pathway
  • child

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