Pediatric emergency department crowding during multiple resuscitation events

Multiple, simultaneous resuscitations in pediatric emergency departments (PEDs) strain resources and exacerbate crowding. In 2015, our pediatric institution implemented a Multiple Resuscitation Activation (MRA) to coordinate team response. The impact of MRAs on PED crowding remains unclear.

Evaluate whether MRAs are associated with changes in PED crowding and patient census.

A retrospective cohort study was conducted at a tertiary pediatric level one trauma center from January 2023 to December 2024. MRA events were matched 1:2 with non-activation control periods by time of day and calendar proximity. Crowding was measured using the Pediatric Emergency Department Overcrowding Scale (PEDOCS) at baseline and at 1 and 2 h after activation (or matched control time). Difference-in-differences analyses were used to compare changes in PEDOCS and patient census between activation and control periods.

Thirteen MRAs involving 59 patients were identified, with a median activation duration of 73 min. Although PEDOCS scores and patient census increased following MRAs, these changes were not significantly different from those in matched control periods. The difference-in-differences estimate for PEDOCS was 6.0 points (95% CI, -15.4 to 27.4) at 1 h and 7.8 points (95% CI, -13.6 to 29.2) at 2 h. Corresponding estimates for patient census were 2 patients (95% CI, -17 to 21) and 6 patients (95% CI, -16 to 28).

MRAs were not associated with significant increases in PED crowding or patient census compared with matched non-activation control periods. These findings suggest that coordinated response systems may help mitigate the operational impact of multiple simultaneous resuscitations.