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How well do General EMS 911 dispatch protocols predict ED resource utilization for pediatric patients?
Stephanie J Fessler1, Harold K Simon2, Arthur H Yancey3
1Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Insights
Emergency Medical Services (EMS) dispatch protocols for pediatric patients did not fully predict resource needs but safely identified most low-acuity cases. A low under-triage rate suggests protocols can be refined for better patient management.
Area of Science:
- Emergency Medicine
- Pediatrics
- Health Services Research
Background:
- Emergency Medical Services (EMS) are frequently used for pediatric patients with low-acuity conditions.
- Existing EMS dispatch protocols, effective for adults, have limited data supporting their use in children.
- There's a need to evaluate the accuracy of EMS protocols in identifying pediatric acuity and resource requirements.
Purpose of the Study:
- To assess pediatric emergency department (PED) resource utilization for children initially categorized as "low-acuity" by EMS dispatch protocols.
- To determine the effectiveness of current EMS protocols in predicting the actual healthcare needs of pediatric patients.
Main Methods:
- A retrospective review of pediatric patients classified as "low-acuity" by EMS and transported to a PED during 2010.
- Data collected included chief complaint, PED visit details, and resource utilization (medications, labs, procedures, admission, transfer).
- Patients were analyzed based on chief complaint groups to identify variations in resource utilization and "under-triage" (low-acuity transport requiring emergent intervention).
Main Results:
- Out of 801 included pediatric patients, 409 (51%) required resource utilization in the PED.
- The majority (737/801) were discharged home, but 64/801 were admitted.
- A low under-triage rate of 0.12% was observed, with only one patient requiring emergent intervention.
Conclusions:
- The studied EMS dispatch protocols demonstrated limitations in accurately predicting overall pediatric resource utilization.
- Despite limitations, the protocols safely identified the majority of low-acuity pediatric patients with a low risk of under-triage.
- Findings suggest potential for refining EMS protocols or implementing secondary triage systems to better manage pediatric transports and resource allocation.
Introduction:
The use of Emergency Medical Services (EMS) for low-acuity pediatric problems is well documented. Attempts have been made to curb potentially unnecessary transports, including using EMS dispatch protocols, shown to predict acuity and needs of adults. However, there are limited data about this in children. The primary objective of this study is to determine the pediatric emergency department (PED) resource utilization (surrogate of acuity level) for pediatric patients categorized as "low-acuity" by initial EMS protocols.
Methods:
Records of all pediatric patients classified as "low acuity" and transported to a PED in winter and summer of 2010 were reviewed. Details of the PED visit were recorded. Patients were categorized and compared based on chief complaint group. Resource utilization was defined as requiring any prescription medications, labs, procedures, consults, admission or transfer. "Under-triage" was defined as a "low-acuity" EMS transport subsequently requiring emergent interventions.
Results:
Of the 876 eligible cases, 801 were included; 392/801 had no resource utilization while 409 of 801 had resource utilization. Most (737/801) were discharged to home; however, 64/801 were admitted, including 1 of 801 requiring emergent intervention (under-triage rate 0.12%). Gastroenterology and trauma groups had a significant increase in resource utilization, while infectious disease and ear-nose-throat groups had decreased resource utilization.
Discussion:
While this EMS system did not well predict overall resource utilization, it safely identified most low-acuity patients, with a low under-triage rate. This study identifies subgroups of patients that could be managed without emergent transport and can be used to further refine current protocols or establish secondary triage systems.
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