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Management of retrieval service patients within a paediatric emergency department
Sarah L Andrews1, Stuart Lewena, Felix Oberender
1Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Victorian Paediatric Emergency Transport Service (PETS) patients often exceed the National Emergency Access Target in the emergency department (ED). Administrative changes can improve timely ward disposition for critically unwell children.
Area of Science:
- Emergency Medicine
- Paediatric Care
- Transport Medicine
Background:
- The Victorian Paediatric Emergency Transport Service (PETS) facilitates critical care transfers for children.
- Patients not admitted directly to intensive care units (ICUs) are often managed in tertiary emergency departments (EDs).
- These critically ill paediatric patients may require extended, high-level care within the ED setting.
Purpose of the Study:
- To describe the cohort of critically unwell children transported by PETS to a tertiary ED.
- To analyze their clinical care needs and process measures.
- To evaluate emergency department length of stay (LOS) in relation to the National Emergency Access Target.
Main Methods:
- Retrospective chart review of 120 patients transported by PETS to the Royal Children's Hospital ED in 2012.
- Extraction of demographic, illness, and process measures.
- Analysis of ED LOS and time to ward suitability based on patient and illness characteristics.
Main Results:
- The median ED LOS was 4.8 hours, with 20.8% of patients exceeding 8 hours.
- Lower respiratory conditions were most common (44 patients).
- Administrative delays, primarily bed block, significantly contributed to prolonged LOS, though 20.8% had ongoing critical illness after 4 hours.
Conclusions:
- Most PETS-retrieved patients are admitted to wards, not ICUs.
- The majority experience ED stays exceeding the National Emergency Access Target.
- Improvements in timely ward disposition are achievable through administrative process changes.
Objective:
The Victorian Paediatric Emergency Transport Service (PETS) transports critically unwell children to tertiary paediatric hospitals. Children not directly admitted to ICU go to a tertiary ED. These patients might require prolonged and high-level care. In light of the National Emergency Access Target, we describe this cohort, clinical care needs and process measures.
Methods:
A retrospective chart review of patients retrieved by PETS to the Royal Children's Hospital (Melbourne, Australia) ED in 2012. Demographics, illness parameters and process measures were extracted. The ED length of stay (LOS) and time to ward suitability (time at which physiological parameters stabilised and high acuity treatments ceased) were related to patient and illness characteristics. Data are presented descriptively and analysed using spss.
Results:
In 2012, 120 patients were transported to the ED. Conditions included lower respiratory (44), neurological (28), upper respiratory (16) and trauma (14). The median ED LOS was 4.8 h (interquartile range 2.9, 7.7). On arrival, 73 (60.8%) were ward-suitable, but 51 (43%) had LOS less than 4 h. Twenty-five (20.8%) patients stayed longer than 8 h. Administrative delay (principally bed block) is responsible for the bulk of the LOS; however, 25 (20.8%) had markedly abnormal vital signs after 4 h of ED care, mainly patients with lower respiratory tract disease.
Conclusion:
Most patients retrieved to the ED ultimately go to a ward rather than ICU and most have an ED stay in excess of National Emergency Access Target. Several retrieval associated care issues, such as timely and appropriate ward disposition, can be addressed by administrative changes.
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