Operational Impact of Redirection From the Pediatric Emergency Department: A Matched Cross-Sectional Study

Area of Science:

• Pediatric Emergency Medicine
• Healthcare Operations Management
• Public Health Policy

Background:

• Emergency Departments (EDs) face crowding challenges, particularly with non-urgent cases.
• Programs redirecting patients to community care (ED2C) aim to alleviate ED crowding.
• Evaluating the impact of ED2C programs on pediatric EDs is crucial for optimizing patient flow.

Purpose of the Study:

• To assess the impact of a pediatric Emergency Department to Community (ED2C) program on patient-level outcomes and ED operations.
• To determine the proportion of eligible patients redirected by the ED2C program.
• To compare the length of stay and return visit rates for redirected versus non-redirected patients.

Main Methods:

• A matched cross-sectional study design was employed.
• Pediatric ED days with the ED2C program were matched to control days based on day type and patient volume.
• Measures of ED flow, utilization, and patient outcomes were compared between the two groups.

Main Results:

• 14.6% of eligible patients (900 out of 6164) were redirected during the study period.
• Redirected patients had a significantly shorter length of stay (LOS) (2.9 hours) compared to eligible non-redirected patients (8.5 hours).
• No significant differences were observed in median departmental LOS, time to physician assessment, hospitalization rates, or ED return visits between program and non-program days.

Conclusions:

• The ED2C program successfully reduced LOS for redirected pediatric patients without negatively impacting return visit rates.
• The program did not significantly alter overall ED operations or flow.
• Refinement of eligibility criteria for pediatric patient redirection is recommended to enhance program effectiveness and ensure patient safety.