Impact of time-of-shift on diagnostic service requests in a pediatric emergency department: a retrospective study

The demand for medical services and its burden on the healthcare system is worldwide increasing. Factors influencing service requests are still partially unknown. Extended shifts may impair decision-making, potentially affecting the request for ancillary diagnostic procedures. This study aimed to investigate the association between the time-of-shift and the rate of diagnostic service requests in pediatric emergency settings. This single-center observational study was conducted at the pediatric emergency department of the Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy. The study included patient visits on weekends and public holidays. Data on blood tests, specialist consultations, and imaging requests were extracted. The shift was divided into the first 8 h and the last 4 h, and diagnostic service requests were analyzed using mixed-effects logistic regression models, adjusting for patient urgency and number of patients per shift. A total of 5370 visits were analyzed. At least one ancillary diagnostic procedure was requested in 31% of the visits. There was a 14% higher probability (p = 0.04) of requiring ancillary diagnostic procedures during the last 4 h of shifts compared to the first 8 h. This probability increased to 20% (p = 0.02) considering exclusively the dayshift. These findings suggest a potential role of shift duration on diagnostic service requests, warranting further multicenter studies to explore this association across various healthcare settings.