Pediatric Respiratory Score in the Triage Form

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Initiatives
• Triage Accuracy

Background:

• Respiratory distress is a frequent pediatric emergency department presentation.
• A retrospective review found 22% of pediatric patients transferred to the ICU for respiratory issues were undertriaged (ESI 3 or 4).
• Undertriaged patients experienced significantly longer provider wait times (1 hr 15 min vs. 43 min).

Purpose of the Study:

• To implement and evaluate a pediatric respiratory score for emergency department triage.
• To reduce wait times for pediatric patients with respiratory distress requiring ICU transfer.
• To decrease door-to-provider and door-to-transfer times.

Main Methods:

• A 15-week quality improvement initiative was conducted.
• Emergency department staff received training on the new pediatric respiratory score.
• Data collected included score utilization, triage accuracy (ESI 1 or 2 for ICU transfers), and door-to-provider/transport times.

Main Results:

• 86.5% of 59 transferred respiratory distress patients were correctly triaged (ESI 1 or 2), an improvement from 78% the prior year.
• Average door-to-provider time decreased to 15 minutes with the score, versus 20 minutes without.
• Average door-to-transport time remained under 10 hours for both groups.

Conclusions:

• The pediatric respiratory score effectively enhances patient assessment at triage.
• Implementation of the score led to improved wait times for pediatric respiratory patients needing ICU transfer.
• The initiative demonstrated success in optimizing emergency care for critically ill children.