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Comparison of care quality between pediatric and general emergency departments: secondary analysis of a national
Bellaure Ndoudi Likoho1, Bénédicte Vrignaud2, François Angoulvant3
1Neonatal Intensive Care Unit, Port Royal, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and Statistics, F-75004 Paris, France.
Insights
French general emergency departments (GEDs) provided different care quality for children compared to pediatric emergency departments (PEDs). Differences in length of stay and transfer rates highlight areas for quality improvement in pediatric emergency care.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Comparative Health Services Research
Background:
- Pediatric emergency care quality can vary between specialized pediatric emergency departments (PEDs) and general emergency departments (GEDs).
- Understanding these differences is crucial for targeted training and quality enhancement initiatives in emergency medicine.
Purpose of the Study:
- To compare the quality of care provided to pediatric patients in French PEDs versus GEDs.
- To identify specific areas for quality improvement and training in emergency departments handling pediatric cases.
Main Methods:
- Secondary analysis of the cross-sectional URGENCE 2013 study data, including 14,711 visits of patients under 18.
- Utilized a set of 10 care quality measures, developed by pediatric emergency medicine experts, for comparison between PEDs and GEDs.
- Employed multilevel analyses to compare general and condition-specific care quality measures between the two types of emergency departments.
Main Results:
- General emergency departments (GEDs) managed a higher proportion of older children and injury visits compared to pediatric emergency departments (PEDs).
- Significant differences in general care quality were observed: GEDs had shorter lengths of stay, lower rates of hospitalization and patients leaving against medical advice, but higher transfer rates.
- No significant differences in condition-specific care quality measures were found between PEDs and GEDs.
Conclusions:
- Observed differences in care quality between PEDs and GEDs are likely influenced by patient visit characteristics.
- Further in-depth analysis of these variations is necessary to effectively improve the quality of emergency care for children.
- The URGENCE 2013 study data offers a valuable resource for continued research into pediatric emergency care quality.
Objective:
To compare the quality of care between French pediatric emergency departments (PEDs) and general emergency departments (GEDs) to identify targets for training and quality improvement.
Methods:
Secondary analysis of a cross-sectional study that included each visit from 731 EDs on June 11th, 2013 (URGENCE 2013). We included all visits of patients younger than 18 years old. A panel of pediatric emergency medicine experts created a list of 10 care quality measures. Care quality measures (i.e., general and condition-specific measures) were compared between PEDs and GEDs using multilevel analyses.
Results:
Out of 14,711 included visits, 8944 (60.8%) occurred in GEDs. Compared with PEDs, GEDs had a higher proportion of visits by children older than 2 years (88.0% vs 71.4%, p < 0.001) and a higher proportion of injury visits (59.2% vs 28.3%, p < 0.001). Five of the ten general care quality measures differed significantly in GEDs compared with PEDs: shorter length of stay (LOS) (β: -18 min, 95% CI: -28 to -8); lower proportions of visits with LOS > 6 h (OR: 0.56, 95% CI: 0.41-0.78), lower proportion of hospitalizations (OR: 0.36, 95% CI: 0.28-0.45), lower proportion of patients who left against medical advice (OR: 0.27, 95% CI: 0.09-0.76), and a higher proportion of transfers (OR: 2.25, 95% CI: 1.38-3.67). There were no significant differences in care quality for the 3 condition-specific measures.
Conclusion:
Differences in care quality measures between PEDs and GEDs may be explained by the characteristics of the included visits. A more precise analysis of those differences is required to improve the quality of care for children in EDs. It would be possible in the recent French cross-sectional study using the same methodology.
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