Changes in hospital prescribing activity at a specialist children’s hospital during the COVID-19 pandemic - an observational study

  1. Emma Vestesson
  2. Carlos Alonso
  3. John Booth
  4. Neil J Sebire
  5. Adam Steventon
  6. Steve Tomlin
  7. Joseph F Standing

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Abstract

Objective

To compare hospital activity, patient casemix and medication prescribing and administration before and during the COVID-19 emergency.

Design

Retrospective observational study

Setting

A specialist children’s hospital in the UK

Patients

Inpatients aged 25 and younger treated at a specialist children’s hospital between 29 April 2019 and 6 September 2020

Results

There were 21,471 day cases and inpatients treated during the 16 month study period. Day cases (no overnight stay) dropped by around 37% per week. Both admissions and discharges for inpatients (at least one overnight stay) decreased leading to a small reduction in hospital bed days but no reduction in hospital bed nights. The effect on hospital activity on different patient groups varied substantially with some groups such as medical oncology day cases increasing by 13%. As a result, the patient case mix in the hospital was very different during the pandemic. Overall weekly medication administrations decreased for day cases and inpatients, but weekly medication administrations per bed day increased by 10% for day cases and 6% for inpatients.

Conclusions

Despite not being badly affected by the disease itself, specialist paediatric hospital services have been greatly affected by the pandemic. The average number of medications per inpatient bed day increased, likely reflecting changes to the patient population, with only those children with severe conditions being treated during the pandemic. These data demonstrate the complex pattern of implications on specialist services and provide evidence for planning the impact of future emergencies and resolution strategies.

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  1. ScreenIT

    SciScore for 10.1101/2020.12.21.20248153: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    One limitation is that the pre-COVID-19 period does not cover the identical calendar months, making it impossible to adjust for factors related to seasonality. Similarly, an extended time period would allow more robust statistical timeseries analyses. As a sensitivity analysis, we used historical admission data from 2016 to 2018 and found similar trends for hospital admissions and discharges. Though this was not possible for all metrics in this study due to differences between the old and new data systems, this sensitivity analysis indicates that the pre-pandemic period is representative of baseline activity. It should also be highlighted that the data we present here is from a highly specialist children’s hospital and patients are not representative of the general paediatric population or children in primary or secondary care settings. We were unable to say whether the patterns of utilisation were appropriate clinically for the needs of the patients or assess the experience of the children and their carers. The COVID-19 pandemic has caused an unprecedented impact on health care systems in the UK and globally. The findings of the current study confirm a significant decrease in the number of day cases being treated at a specialist children’s hospital but inpatient activity for children with rare and complex disorders was less affected. There is however wide variation between treatment specialities, leading to some patient groups having been virtually unaffected and others seve...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.12.21.20248153v1 on medRxiv