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Published on: November 9, 2016
The impact of critically ill children on paediatric ED medication timeliness
Kenneth A Michelson1, Richard G Bachur1, Jason A Levy1
1Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
The presence of critically ill children in the pediatric emergency department (ED) is linked to delays in medication for other patients. Higher patient census also independently predicted these medication delays.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
Background:
- Critically ill patients can strain emergency department (ED) resources.
- This strain may impact the timeliness of care for non-critically ill patients.
Purpose of the Study:
- To determine if the presence of a critically ill child in the ED affects the time to medication administration for other patients.
- To assess the association between critically ill patients and the delivery of diagnosis-specific medications.
Main Methods:
- Retrospective cohort study of pediatric ED visits over three years.
- Analysis of medication times, comparing patients exposed to critically ill children with unexposed patients.
- Median regression modeling adjusted for demographics, arrival time, weekday, and ED census.
Main Results:
- Median time to first medication increased with the number of simultaneous critically ill patients (90 min for 0, 96 min for 1, 113 min for >1).
- Modelled time to first medication increased by 3.1 minutes for exposed patients (p=0.02).
- Each 10-patient increase in ED census was associated with a 15.3-minute increase in time to first medication.
Conclusions:
- The presence of critically ill children in the ED is associated with delays in medication administration for other patients.
- Increased ED patient census is an independent predictor of medication delays.
Objectives:
The presence of critically ill patients may impact care for other ED patients. We sought to evaluate whether the presence of a critically ill child was associated with the time to (1) receipt of the first medication among other patients, and (2) administration of diagnosis-specific medications.
Methods:
We performed a retrospective cohort study of all paediatric ED visits over 3 years. Patients were exposed if they arrived during the first hour of a critically ill patient's care. The primary outcome was the time from arrival to first medication administration. Secondary outcomes were time to corticosteroids in asthma and time to antibiotics for fever/neutropenia. We modelled times to medication using median regression, adjusting for demographics, arrival time and weekday, and census (number of patients in the ED).
Results:
We analysed 170 112 visits. Median times to first medication for those exposed to 0, 1 and >1 simultaneous critically ill patients were 90 min (IQR 54-146), 96 min (IQR 58-157) and 113 min (IQR 72-166), respectively (p<0.001). The increase in time to corticosteroids among exposed patients versus unexposed was 6 min (IQR 2-14, p=0.11) and in time to antibiotic for fever/neutropenia was -4 min (IQR -4 to -11, p=0.13). Modelled time to first medication increased 3.1 min (95% CI 0.5 to 5.7) among all exposed patients (p=0.02). Time to first medication increased 15.3 min (95% CI 14.7 to 15.9) for each 10 patient increase in census.
Conclusions:
The presence of critically ill patients was associated with a delay in medication administration to others. Census independently predicted medication delays.
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