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Scoping a paediatric emergency medicine unit
Marita S Bolic1, Jamie Lew2, Drew B Richardson3,4
1James Cook University, College of Medicine and Dentistry, Cairns, Queensland, Australia.
Insights
A paediatric emergency medicine unit (PEMU) can effectively manage common childhood illnesses like bronchiolitis and asthma, with low admission rates. Further research is needed to expand suitable patient cohorts for PEMU.
Area of Science:
- Emergency Medicine
- Paediatric Care
- Health Services Research
Background:
- Tertiary mixed adult/paediatric emergency departments (EDs) manage a high volume of paediatric presentations annually.
- The establishment of a paediatric emergency medicine unit (PEMU), or short stay unit, can optimize care for specific paediatric patient cohorts.
- Defining suitable patient profiles and diagnoses is crucial for the successful implementation and operation of a PEMU.
Purpose of the Study:
- To characterize paediatric patient presentations at Canberra Hospital ED.
- To identify patient cohorts and diagnoses suitable for a newly proposed paediatric emergency medicine unit (PEMU).
- To assess the potential daily patient volume and resource requirements for a PEMU.
Main Methods:
- Retrospective descriptive study of paediatric (<16 years) ED presentations at Canberra Hospital from May to August 2022.
- Patients with ED length of stay >4 hours or non-surgical admission <2 nights were classified as PEMU-suitable.
- Clinical practice guidelines were utilized to assess disease severity based on ED findings.
Main Results:
- Of 8,340 paediatric ED episodes, 1,377 (64.8%) were retrospectively identified as PEMU-suitable.
- An average of 11.9 potential PEMU-suitable cases were identified daily during the study period.
- Common diagnoses like mild bronchiolitis, mild asthma, and simple febrile seizures showed low inpatient ward admission rates (≤17%) and were well-suited for PEMU.
Conclusions:
- Several common paediatric diagnoses are appropriate for management within a PEMU, demonstrating feasible occupancy and length of stay.
- The low inpatient admission rate for identified conditions suggests that less common paediatric diagnoses may also be suitable for PEMU care.
- Further research is recommended to identify additional paediatric patient groups and diagnoses suitable for PEMU and to validate findings across a full year.
Objective:
To describe the characteristics and potential patient cohorts suitable for a paediatric emergency medicine unit (PEMU), otherwise known as a short stay unit, at Canberra Hospital, a tertiary mixed adult/paediatric ED treating 98 000 patients annually.
Method:
Retrospective descriptive study of paediatric (aged <16) presentations to Canberra Hospital ED between May and August 2022. Patients discharged from ED with a length of stay exceeding 4 h and those admitted non-surgically for less than 2 nights were deemed PEMU suitable; those requiring admission for >2 nights were classed as inpatient ward admission (IWA) patients. Royal children's hospital clinical practice guidelines were used where available to classify the severity of disease via features apparent in ED.
Results:
Eight thousand three hundred and forty episodes were identified as paediatric ED presentations, with 1377 (64.8%, 95%CI 62.8-66.9) retrospectively PEMU suitable. This winter sample identified an average of 11.9 potential PEMU suitable cases daily. Chart review showed clinically mild bronchiolitis, mild asthma, anaphylaxis, mild gastroenteritis, afebrile seizure - no known seizure diagnosis, and simple febrile seizures had an excellent profile for PEMU, with subsequent ward admission rates of 17% or less. A mean 7-h stay would require 5 beds with 66% occupancy over 24 h.
Conclusions:
Several common paediatric diagnoses are well-suited to a PEMU unit, with reasonable occupancy and length of stay. The low inpatient admission rate suggests less common diagnoses should also be regarded as suitable. Further research is required to identify other paediatric patients and diagnoses suitable for PEMU, and to ratify findings in a whole-of-year sample.
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