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Dedicated Pediatricians in Emergency Department: Shorter Waiting Times and Lower Costs
Manuel Rocha Melo1,2, Manuel Ferreira-Magalhães1,3, Filipa Flor-Lima1
1Department of Pediatrics, Integrated Pediatric Hospital, Centro Hospitalar de S. João, Porto, Portugal.
Insights
Dedicated emergency pediatricians in pediatric emergency departments (EDs) reduce costs and waiting times without compromising clinical outcomes. This study evaluated the net benefits and costs of these specialists.
Area of Science:
- Pediatric Emergency Medicine
- Health Economics
- Healthcare Management
Background:
- Dedicated pediatricians in emergency departments (EDs) may offer benefits, but their cost-effectiveness is unstudied.
- Previous research has not assessed the costs, benefits, or harms of dedicated pediatric emergency physicians.
- This study aimed to evaluate the net benefits and costs of dedicated emergency pediatricians in a pediatric ED.
Purpose of the Study:
- To assess the impact of dedicated emergency pediatricians on clinical outcomes, patient throughput, and costs in a pediatric ED.
- To compare the cost-consequences of a pediatric ED staffed by general pediatricians versus one with dedicated emergency pediatricians.
Main Methods:
- A cost-consequences analysis was conducted comparing two medical teams (MT-A: general pediatricians, MT-B: dedicated emergency pediatricians) in a tertiary hospital's pediatric ED.
- Data were collected over two comparable periods: May-September 2012 (MT-A) and May-September 2013 (MT-B).
- Key outcomes included clinical results, patient throughput time (time to first medical observation), and costs per patient.
Main Results:
- The study included 8,694 children in MT-A and 9,417 in MT-B.
- Medication use increased, while diagnostic tests decreased in MT-B. Hospitalization rates rose, but the severity of hospitalized cases remained similar.
- Patient throughput time was significantly shorter with dedicated pediatricians (MT-B), and total expenditures per child decreased by 16% (€37.87 in MT-A vs. €31.97 in MT-B).
Conclusions:
- Dedicated emergency pediatricians in pediatric EDs are associated with significantly reduced waiting times and lower costs.
- Clinical outcomes, including ED readmissions and patients leaving without being seen, were similar between groups.
- The findings suggest that dedicated emergency pediatricians improve efficiency and reduce costs in pediatric emergency care without negatively impacting patient safety or clinical results.
Background:
Dedicated pediatricians in emergency departments (EDs) may be beneficial, though no previous studies have assessed the related costs and benefits/harms. We aimed to evaluate the net benefits and costs of dedicated emergency pediatricians in a pediatric ED.
Methods:
Cost-consequences analysis of visits to a pediatric ED of a tertiary hospital. Two pediatric ED Medical Teams (MT) were compared: MT-A (May-September 2012), with general pediatrics physicians only; and MT-B (May-September 2013), with emergency dedicated pediatricians. The main outcomes analyzed were relevant clinical outcomes, patient throughput time and costs.
Results:
We included 8,694 children in MT-A and 9,417 in MT-B. Medication use in the ED increased from 42.3% of the children in MT-A to 49.6% in MT-B; diagnostic tests decreased from 24.2% in MT-A to 14.3% in MT-B. Hospitalization increased from 1.3% in MT-A to 3.0% in MT-B; however, there was no significant difference in diagnosis-related group relative weight of hospitalized children in MT-A and MT-B (MT-A, 0.979; MT-B, 1.075). No differences were observed in ED readmissions or in patients leaving without being seen by a physician. The patient throughput time was significantly shorter in MT-B, with faster times to first medical observation. Within the cost domains analyzed, the total expenditures per children observed in the ED were 16% lower in MT-B: 37.87 euros in MT-A; 31.97 euros in MT-B.
Conclusion:
The presence of dedicated emergency pediatricians in a pediatric ED was associated with significantly lower waiting times in the ED, reduced costs, and similar clinical outcomes.
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