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Emergency Department Care for Children During the 2022 Viral Respiratory Illness Surge
Alexander T Janke1,2,3, Courtney W Mangus2,4, Christopher M Fung1
1National Clinician Scholars Program, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
Insights
During a 2022 viral surge, children's hospitals saw longer emergency department (ED) wait times and lengths of stay (LOS). High visit volumes increased ED revisits across all pediatric care settings.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Quality Improvement Science
Background:
- Pediatric readiness is crucial for all emergency departments (EDs).
- Children's emergency care experiences can be impacted by operational challenges during viral illness surges.
- Children's hospitals, community hospitals, and rural EDs face unique challenges during these surges.
Purpose of the Study:
- To analyze wait times, lengths of stay (LOS), and ED revisit rates.
- To compare these metrics across diverse ED settings during a 2022 viral illness surge.
- To identify disparities in pediatric emergency care during periods of high patient volume.
Main Methods:
- Retrospective cohort study of 25 EDs in Michigan from January 2021 to December 2022.
- Analysis of pediatric (age <18 years) encounters for viral and respiratory conditions.
- Comparison of wait times, LOS, and ED revisit rates across children's hospitals, urban high-volume, urban low-volume, and rural EDs during a surge period (September-December 2022).
Main Results:
- A surge in pediatric viral/respiratory visits (71.8% increase) occurred from September-December 2022.
- Children's hospitals experienced prolonged wait times (8.0% >4 hrs) and LOS (8.6% >12 hrs) during the surge.
- Increased ED revisits were associated with high visit volumes across all ED types; prolonged LOS affected 2.2-3.1% of visits in non-children's hospitals.
Conclusions:
- Pediatric viral illness surges significantly impact ED operations and patient care timelines.
- Children's hospitals faced disproportionate challenges with wait times and LOS during the surge.
- Collaborative quality improvement efforts and strong inter-ED relationships are vital for mitigating risks during surges.
Importance:
Pediatric readiness is essential for all emergency departments (EDs). Children's experience of care may differ according to operational challenges in children's hospitals, community hospitals, and rural EDs caused by recurring and sometimes unpredictable viral illness surges.
Objective:
To describe wait times, lengths of stay (LOS), and ED revisits across diverse EDs participating in a statewide quality collaborative during a surge in visits in 2022.
Design, Setting, And Participants:
This retrospective cohort study included 25 EDs from the Michigan Emergency Department Improvement Collaborative data registry from January 1, 2021, through December 31, 2022. Pediatric (patient age <18 years) encounters for viral and respiratory conditions were analyzed, comparing wait times, LOS, and ED revisit rates for children's hospital, urban pediatric high-volume (≥10% of overall visits), urban pediatric low-volume (<10% of overall visits), and rural EDs.
Exposures:
Surge in ED visit volumes for children with viral and respiratory illnesses from September 1 through December 31, 2022.
Main Outcomes And Measures:
Prolonged ED visit wait times (arrival to clinician assigned, >4 hours), prolonged LOS (arrival to departure, >12 hours), and ED revisit rate (ED discharge and return within 72 hours).
Results:
A total of 2 761 361 ED visits across 25 EDs in 2021 and 2022 were included. From September 1 to December 31, 2022, there were 301 688 pediatric visits for viral and respiratory illness, an increase of 71.8% over the 4 preceding months and 15.7% over the same period in 2021. At children's hospitals during the surge, 8.0% of visits had prolonged wait times longer than 4 hours, 8.6% had prolonged LOS longer than 12 hours, and 42 revisits occurred per 1000 ED visits. Prolonged wait times were rare among other sites. However, prolonged LOS affected 425 visits (2.2%) in urban high-pediatric volume EDs, 133 (2.6%) in urban pediatric low-volume EDs, and 176 (3.1%) in rural EDs. High visit volumes were associated with increased ED revisits across sites.
Conclusions And Relevance:
In this cohort study of more than 2.7 million ED visits, a pediatric viral illness surge was associated with different pediatric acute care across EDs in the state. Clinical management pathways and quality improvement efforts may more effectively mitigate dangerous clinical conditions with strong collaborative relationships across EDs and setting of care.
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