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Medical complexity and pediatric emergency department and inpatient utilization

Lila O'Mahony1, D Shane O'Mahony, Tamara D Simon

  • 1Emergency Services, Seattle Children's Hospital, 4800 Sand Point Way NE, B-5506, Seattle, WA, USA. lila.omahony@seattlechildrens.org

Pediatrics
|January 16, 2013
PubMed

Insights

Children with chronic conditions account for 20% of pediatric emergency department (PED) visits and experience longer stays and higher admission rates. Increased medical complexity correlates with greater resource utilization in the PED.

Area of Science:

  • Pediatric Emergency Medicine
  • Health Services Research
  • Clinical Informatics

Background:

  • Children with chronic conditions represent a substantial patient group within pediatric emergency departments (PEDs).
  • Understanding their resource utilization patterns is crucial for optimizing care and resource allocation.
  • Medical complexity varies significantly among children with chronic conditions, potentially impacting their healthcare needs.

Purpose of the Study:

  • To characterize the utilization and disposition of pediatric emergency department (PED) services by children with chronic conditions.
  • To analyze how varying degrees of medical complexity influence PED use and patient outcomes.
  • To identify potential tools for managing high-utilizing patient populations.

Main Methods:

  • Retrospective cohort study of 77,748 PED visits from January 1, 2008, to December 31, 2009.
  • Classification of medical complexity using Clinical Risk Group (CRG) software into nonchronic and chronic categories (episodic, lifelong, progressive, malignancy).
  • Analysis of PED length of stay (LOS) and disposition, with logistic regression for age-adjusted odds ratios (AOR) of admission.

Main Results:

  • Children with chronic conditions constituted 20% of all PED visits.
  • These children had significantly longer PED LOS (79 minutes longer) and higher rates of hospital (51% vs. 10%) and PICU (3.2% vs. 0.1%) admission compared to those without chronic conditions.
  • Increased medical complexity was directly associated with longer PED LOS and higher admission rates.

Conclusions:

  • Children with chronic conditions are significant users of tertiary pediatric emergency department resources.
  • Medical complexity is a key factor associated with increased PED length of stay and hospital/PICU admissions.
  • Clinical Risk Group (CRG) software can aid in identifying high-need patients and developing targeted interventions for efficient PED management.
Abstract

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