Quality of Care of Children in the Emergency Department: Association with Hospital Setting and Physician Training (original) (raw)
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Patient-level Factors and the Quality of Care Delivered in Pediatric Emergency Departments
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2017
Quality of care delivered to adult patients in the emergency department (ED) is often associated with demographic and clinical factors such as a patient's race/ethnicity and insurance status. We sought to determine whether the quality of care delivered to children in the ED was associated with a variety of patient-level factors. This was a retrospective, observational cohort study. Pediatric patients (<18 years) who received care between January 2011 and December 2011 at one of 12 EDs participating in the Pediatric Emergency Care Applied Research Network (PECARN) were included. We analyzed demographic factors (including age, sex, and payment source) and clinical factors (including triage, chief complaint, and severity of illness). We measured quality of care using a previously validated implicit review instrument using chart review with a summary score that ranged from 5 to 35. We examined associations between demographic and clinical factors and quality of care using a hiera...
A Comparison of Resource Utilization Between Emergency Physicians and Pediatric Emergency Physicians
Pediatric Emergency Care, 2012
Objectives: Pediatric patients in the emergency department (ED) are typically seen either by general emergency physicians (EPs) or by pediatric emergency physicians (PEPs) who have completed either a fellowship in pediatric emergency medicine or both pediatric and emergency medicine residencies. This study evaluates admission rates, turnaround times, and test and medication utilization for EPs versus PEPs. Methods: A retrospective chart analysis was conducted at an academic tertiary care hospital with a dedicated pediatric ED. When the pediatric ED is open (from noon to midnight), it is always staffed with dedicated pediatric nurses and residents. In our ED, the only variable is the attending physician, who can either be an EP or a PEP. All visits for patients younger than 18 years who presented during the time the pediatric ED was open from July 1, 2007, to June 30, 2010, were eligible for inclusion. Only patients seen by physicians who saw more than 400 patients during this period were included. Disposition outcomes for patients who were either admitted or discharged were compared between EPs and PEPs. Complete blood count, Chem 7, urinalysis, chest radiography ordering rates, and intravenous fluid and ondansetron administration were used as surrogates for general conclusions about test utilization. Results: There were 13,347 patient visits eligible for inclusion, of which 8330 (62.4%) were seen by 2 PEPs, and 5017 (37.6%) were seen by 9 EPs. There was a difference in mean patient age (6.9 vs 7.1 years, P = 0.01), whereas sex (53.6% vs 53.9% male, P = 0.72), race (P = 0.13), acuity (mean Emergency Severity Index 3.35 vs 3.33, P = 0.99), and mode of arrival (10.6% vs 12.3% emergency medical services transport, P = 0.06) were not significantly different. Overall admission rates were similar (17.1% PEP vs 17.5% EP, P = 0.50), as were critical care admissions (2.9% PEP vs 2.7% EP of total admissions, P = 0.40). Turnaround times were significantly different (146.0 T 2.5 minutes PEP vs 149.7 T 3.2 minutes EP, P = 0.04). Ordering rates of Chem 7, urinalyses, chest radiographs, and ondansetron were lower by PEPs. Conclusions: In our pediatric ED, which represents a natural experiment where the type of physician is the only variable, PEPs and EPs have similar rates of admission to floor beds and critical care. Pediatric EPs are slightly faster at throughput and order fewer tests and medication.
Comparing Practice Patterns Between Pediatric and General Emergency Medicine Physicians
Pediatric Emergency Care, 2017
Objective: Acutely ill infants and children presenting to the emergency department are treated by either physicians with pediatric emergency medicine (PEM) training or physicians without PEM training, a good proportion of which are general emergency medicine-trained physicians (GEDPs). This scoping review identified published literature comparing the care provided to infants and children (≤21 years of age) by PEMtrained physicians to that provided by GEDPs. Methods: The search was conducted in 2 main steps as follows: (1) initial literature search to identify available literature with evolving feedback from the group while simultaneously deciding search concepts as well as inclusion and exclusion criteria and (2) modification of search concepts and conduction of search using finalized concepts as well as review and selection of articles for final analysis using set inclusion criteria. Each study was independently assessed by 2 reviewers for eligibility and quality. Data were independently abstracted by reviewers, and authors were contacted for missing data. Results: Our search yielded 3137 titles and abstracts. Twenty articles reporting 19 studies were included in the final analysis. The studies were grouped under type of care, diagnostic studies, medication administration, and process of care. The studies addressed differences in the management of fever, croup, bronchiolitis, asthma, urticaria, febrile seizures, and diabetic ketoacidosis. Conclusions: This review highlights the lack of robust studies and heterogeneity of literature comparing practice patterns of PEM-trained physicians with GEDPs. We have outlined a systematic approach to reviewing a body of literature for topics that lack clear terms of comparison across studies.
Emergency Department Quality: An Analysis of Existing Pediatric Measures
Academic Emergency Medicine, 2011
Objectives: The Institute of Medicine (IOM) has recommended the development of national standards for the measurement of emergency care performance. The authors undertook this study with the goals of enumerating and categorizing existing performance measures relevant to pediatric emergency care. Methods: Potential performance measures were identified through a survey of 1) the peer-reviewed literature, 2) websites of organizations and societies pertaining to quality improvement, and 3) emergency department (ED) directors. Performance measures were enumerated and categorized, using consensus methods, on three dimensions: 1) the IOM quality domains; 2) Donabedian's structure ⁄ process ⁄ outcome framework; and 3) general, cross-cutting, or disease-specific measures. Results: A total of 405 performance measures were found for potential use for pediatric emergency care. When categorized by IOM domain, nearly half of the measures were related to effectiveness, while only 6% of measures addressed patient-centeredness. In the Donabedian dimension, 67% of measures were categorized as process measures, with 29% outcome and 4% structure measures. Finally, 31% of measures were general measures relevant to every ED visit. Although 225 measures (55%) were diseasespecific, the majority (56%) of these measures related to only five common conditions. Conclusions: A wide range of performance measures relevant to pediatric emergency care are available. However, measures lack a systematic and comprehensive approach to evaluate the quality of care provided.
Variation in emergency department admission rates in US children's hospitals
Pediatrics, 2014
To measure the hospital-level variation in admission rates for children receiving treatment of common pediatric illnesses across emergency departments (EDs) in US children's hospitals. We performed a multi-center cross sectional study of children presenting to the EDs of 35 pediatric tertiary-care hospitals participating in the Pediatric Health Information System (PHIS). Admission rates were calculated for visits occurring between January 1, 2009, and December 31, 2012, associated with 1 of 7 common conditions, and corrected to adjust for hospital-level severity of illness. Conditions were selected systematically based on frequency of visits and admission rates. A total of 1288706 ED encounters (13.8% of all encounters) were associated with 1 of the 7 conditions of interest. After adjusting for hospital-level severity, the greatest variation in admission rates was observed for concussion (range 5%-72%), followed by pneumonia (19%-69%), and bronchiolitis (19%-65%). The least vari...
Israel Journal of Health Policy Research, 2020
Background: Return visits to the emergency department are viewed as a quality measure of patient management. Avoiding unnecessary admissions to the ward can potentially cause an increase in return visits, thus effecting quality assessment. Methods: After implementing an educational process the relationship between admissions and return visits was assessed over time at a rapidly growing pediatric emergency department. Results: There was a 264% increase in visits from 2004 to 2017. In the study period admission rates declined from 25 to 14%. This was achieved without a rise in return visits and with a stable percentage of admissions from return visits. Conclusions: Interventions aimed at decreasing unnecessary admissions do not lead to increased return visits and return visit admissions.
Annals of the Academy of Medicine, Singapore, 2020
INTRODUCTION Paediatric patients presenting to the general emergency departments (EDs) differ from those presenting to paediatric EDs. General EDs vary in preparedness to manage paediatric patients, which may affect delivery of emergency care with varying clinical outcomes. We aimed to elucidate the differences in utilisation patterns of paediatric and general EDs by paediatric patients. METHODS This study was conducted in a public healthcare cluster in Singapore consisting of 4 hospitals. A retrospective review of the medical records of paediatric patients, defined as age younger than 16 years old, who attended the EDs from 1 January 2015 to 31 December 2018, was performed. Data were collected using a standardised form and analysed. RESULTS Of the 704,582 attendances, 686,546 (97.4%) were seen at the paediatric ED. General EDs saw greater number of paediatric patients in the emergent (P1) category (921 [5.1%] versus 14,829 [2.2%]; P<0.01) and those with trauma-related presentati...
Pediatric use of emergency departments
Journal of Pediatric Health Care, 1989
This cross-sectional survey examined the use of emergency services by children, from birth to 16 years of age, in two urban teaching hospitals. A retrospective chart survey design was used to obtain data on the prevalence of types of patient problems; the pattern of use, including time of day and day of week; and decisions regarding patient disposition. A random sample of 10% of the average monthly pediatric emergency visits was obtained for a l&month period and relevant data were extracted by trained research assistants. Variation in the presenting health care problems by age group, season of the year, and by time of day and day of the week was found. Approximately 50% of visits involved such primary health care problems as soft tissue injuries, and respiratory and digestive tract infections. Possible reasons for this use of emergency departments for primary care needs are discussed and strategies are suggested for the provision of a better "fit" between consumer demand and health care services. I PEDIATR HEALTH CARE. (1989). 3, 204-210.