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Paediatric emergency department overcrowding and adverse patient outcomes

Melissa Chan1, Garth Meckler2, Quynh Doan2

  • 1Division of Emergency Medicine, Department of Pediatrics, University of Alberta, Stollery Children's Hospital,Edmonton, Alberta.

Paediatrics & Child Health
|February 27, 2018
PubMed

Insights

Pediatric emergency department (PED) crowding, measured by patients leaving without being seen (LWBS) and longer length of stay (LOS), is linked to increased hospital admissions and intensive care unit (PICU) stays.

Area of Science:

  • Pediatric Emergency Medicine
  • Healthcare Operations Research
  • Public Health

Background:

  • Emergency department crowding negatively impacts patient care and increases morbidity.
  • Understanding pediatric emergency department (PED) flow is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To determine if pediatric emergency department (PED) flow markers are independently associated with adverse outcomes.
  • To investigate the link between PED flow and increased healthcare utilization.

Main Methods:

  • Retrospective cohort study of PED visits from 2008-2012 using electronic administrative data.
  • Multivariate logistic regression models assessed associations between PED flow markers (mean shift length of stay [LOS], daily rate of patients leaving without being seen [LWBS]) and adverse outcomes.
  • Adverse outcomes included hospital/pediatric intensive care unit [PICU] admission, unscheduled return visits, and mortality.

Main Results:

  • Increased daily LWBS proportion associated with higher odds of hospital admission (OR: 2.1) and PICU admission (OR: 8.9).
  • Longer mean shift LOS (3rd/4th quartile) significantly increased odds of admission.
  • Higher daily LWBS proportion correlated with lower odds of unscheduled return visits (OR: 0.4).

Conclusions:

  • Measures of pediatric emergency department (PED) flow are associated with adverse outcomes and increased healthcare utilization.
  • Further research is needed to establish causality between PED overcrowding and admission rates.
Abstract

Keywords:
CrowdingEmergencyPaediatric

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