After the literature review generated a low yield, the SEARCH participant contacted the Canadian Association of Paediatric Health Centers (CAPHC), whose members are the 16 Paediatric Tertiary care teaching centers across Canada. Via the Canadian Pediatrics Decision Support Network (CPDSN), all the 16 centers were contacted were asked how decisions were made around Paediatric admissions with a focus on choosing between Tertiary care and Community Hospital beds. Seven of 15 centers responded, and of those, this question was only relevant to 3 hospitals. The SEARCH participant contacted these specific hospitals and a 45 minute semi-structured interview was conducted to explore their established admission processes.
Very little consensus was documented in the literature and most of the literature dealt with physical requirements of Emergency Departments and hospitals, risk of admission assessment measures, or were not describing the paediatric population but were valuable in general terms. Two articles were from a major Canadian center describing their admission practices and were directly applicable to the project.
Two centers described their systems of diverting Level II patients to outlying paediatric units in community hospitals while retaining the Level III patients at the Tertiary care paediatric center. The third center described a reduced need for community hospital paediatric beds and inferred a potential bed reduction in these hospitals.
The results of the study was used as background research by a clinical working group to establish clinical guidelines to be used when a child presents in one of the Emergency Departments and the decision is made to admit the child. The guidelines will be evaluated at regular intervals.