Comparative effectiveness of Direct Admission and Admissions through Emergency Departments for Children

Motivation and Aims:

Approximately 2 million children are hospitalized each year in the United States, with more than three-quarters of non-elective hospitalizations admitted through emergency departments (EDs). Direct admission, defined as admission to hospital without first receiving care in the hospital’s ED, may offer benefits for patients and healthcare systems in quality, timeliness, and experience of care. While ED utilization patterns are well studied, there is a paucity of research comparing the effectiveness of direct and ED admissions. The overall aim of this project is to compare the effectiveness of a standardized direct admission approach to admission beginning in the ED for hospitalized children.

Novel Approach:

• First randomized controlled trial to compare the effectiveness of direct admission to admission through the ED for pediatric patients.
• Pairing a stepped wedge design with a multi-level assessment of barriers to and facilitators of implementation, will generate valuable data about how positive findings can be reproduced across other healthcare systems.

Featured Publications & Study Protocols:

Leyenaar JK, Acquilano SC, Freyleue SD, Schaefer AP, McDaniel CE, Bode RS, Erdem G, Lauden S, Schmerge C, Choi SS, Felman K, Fleischer A, Houtrow AJ, Bruce ML, O’Malley AJ. Effectiveness of Direct Admission Compared to Admission Through the Emergency Department: A Stepped-Wedge Cluster-Randomized Trial. Pediatrics. 2024 Oct 1;154(4) pii: e2024065776. doi: 10.1542/peds.2024-065776. PMID: 39301600

Taylor JA, McDaniel CE, Stevens CA, Jacob-Files E, Acquilano SC, Freyleue SD, Bode R, Erdem G, Felman K, Lauden S, Bruce ML, Leyenaar JK. Direct Admission Program Implementation: A Qualitative Analysis of Variation Across Health Systems. Pediatrics. 2024 Apr 1;153(4):e2023063569. doi: 10.1542/peds.2023-063569. PMID: 38533563.

McDaniel CE, Arthur KC, Arakelyan M, Stevens C, Montalbano A, Ojugbele O, Leyenaar JK. Understanding trust between pediatric hospitalists and outpatient clinicians during hospital admissions: A multisite qualitative analysis. J Hosp Med. 2022 Apr;17(4):268-275. doi: 10.1002/jhm.12818. Epub 2022 Apr 5. PMID: 35675557.

Leyenaar JK, McDaniel CE, Arthur KC, Stevens CA, St Ivany AR. Healthcare Quality for Acute Illness during the COVID-19 Pandemic: A Multisite Qualitative Analysis. Pediatr Qual Saf. 2021 Sep 24;6(5):e476. doi: 10.1097/pq9.0000000000000476. PMID: 34589650; PMCID: PMC8476062.

Leyenaar JK, McDaniel CE, Acquilano SC, Schaefer AP, Bruce ML, O’Malley AJ. Comparative effectiveness of direct admission and admission through emergency departments for children: a randomized stepped wedge study protocol. Trials. 2020 Nov 30;21(1):988. doi: 10.1186/s13063-020-04889-9. PMID: 33256850; PMCID: PMC7706271.

Funding: This work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Project Program Award (IHS-2018C2-12902-IC).
Disclaimer: All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.