Management of children visiting the emergency department during out-of-office hours: an observational study
Gina Schinkelshoek1, Dorine M Borensztajn1, Joany M Zachariasse1
1Department of General Paediatrics, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands.
Insights
Children presenting to emergency departments at night are younger and sicker, requiring more treatment and hospital admissions. This highlights the need for improved 24-hour emergency care for pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Management
- Comparative Health Services Research
Background:
- Investigating pediatric emergency department (ED) utilization and care patterns outside standard office hours is crucial for optimizing patient outcomes.
- Understanding variations in care delivery during evenings, nights, and weekends is essential for ensuring equitable access to high-quality pediatric emergency services.
Purpose of the Study:
- To characterize and compare the patient demographics and clinical management of children presenting to emergency departments during out-of-office hours versus regular office hours.
- To identify potential disparities in diagnostic testing, treatment, and admission rates based on the time of emergency department visit.
Main Methods:
- A retrospective analysis of electronic health records from 119,204 pediatric visits across five emergency departments in four European countries.
- Comparison of patient characteristics and management strategies (diagnostic tests, treatments, hospital/pediatric intensive care unit admissions) between visits during office hours and out-of-office hours (evenings, nights, weekends).
- Statistical analyses were adjusted for key variables including age, gender, triage urgency, vital signs, presenting problems, and hospital site.
Main Results:
- Children presenting during night shifts were younger, more often high urgency, and had more abnormal vital signs compared to office hours.
- After adjusting for disease severity, diagnostic testing (laboratory and radiological) was less frequent during night shifts (aOR 0.82 and 0.64, respectively).
- Treatment was more likely (aOR 1.56) and hospital admission rates were higher (aOR 1.32) for children seen at night, with comparable management patterns across different hospitals.
Conclusions:
- Children presenting to emergency departments at night are generally more critically ill, underscoring the importance of robust 24-hour emergency care systems.
- Observed differences in management during out-of-office hours warrant further investigation to understand their impact on pediatric patient outcomes.
- Continued efforts are needed to enhance the quality and consistency of emergency care provided on a 24/7 basis for children.
Background:
The aim was to study the characteristics and management of children visiting the emergency department (ED) during out-of-office hours.
Methods:
We analysed electronic health record data from 119 204 children visiting one of five EDs in four European countries. Patient characteristics and management (diagnostic tests, treatment, hospital admission and paediatric intensive care unit admission) were compared between children visiting during office hours and evening shifts, night shifts and weekend day shifts. Analyses were corrected for age, gender, Manchester Triage System urgency, abnormal vital signs, presenting problems and hospital.
Results:
Patients presenting at night were younger (median (IQR) age: 3.7 (1.4-8.2) years vs 4.8 (1.8-9.9)), more often classified as high urgent (16.3% vs 9.9%) and more often had ≥2 abnormal vital signs (22.8% vs 18.1%) compared with office hours. After correcting for disease severity, laboratory and radiological tests were less likely to be requested (adjusted OR (aOR): 0.82, 95% CI 0.78-0.86 and aOR: 0.64, 95% CI 0.60-0.67, respectively); treatment was more likely to be undertaken (aOR: 1.56, 95% CI 1.49-1.63) and patients were more likely to be admitted to the hospital (aOR: 1.32, 95% CI 1.24-1.41) at night. Patterns in management during out-of-office hours were comparable between the different hospitals, with variability remaining.
Conclusions:
Children visiting during the night are relatively more seriously ill, highlighting the need to keep improving emergency care on a 24-hour-a-day basis. Further research is needed to explain the differences in management during the night and how these differences affect patient outcomes.
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