Trends in use in a Canadian pediatric emergency department

Abstract

Introduction: Emergency department (ED) crowding is a significant problem in Canada and has been associated with decreased quality of care in general and pediatric emergency departments (PEDs). Although boarding of admitted patients in the ED is the main contributor to adult ED overcrowding, factors involved in PED crowding may be different. The objective of this study was to report the trend in PED services use and to document the degree of overcrowding experienced in a Canadian PED. Methods: A retrospective cohort study was conducted using administrative data from a tertiary care PED from 2002 to 2011. The primary outcome was PED use (total volume of visits and case severity per triage levels using the Canadian Triage and Acuity Scale [CTAS] score and admissions). Secondary outcomes included measures of PED overcrowding, such as rates of patients leaving without being seen (LWBS) and length of stay (LOS).Results: Total volumes increased by 30% over the 10-year study period, whereas hospitalizations remained stable at approximately 10%. Trends in CTAS levels did not indicate meaningful changes in the severity of cases treated at our PED. LWBS proportions among CTAS 3, CTAS 4, and CTAS 5 groups and LOS for all CTAS groups progressively and statistically increased from year to year. Conclusions: Over the course of the study period, there was a substantial increase in PED visits, which likely contributed to the worsening markers of PED flow outcomes. Further study into the effects of PED crowding on patient outcomes is warranted.

Trends in Pediatric Emergency Department Utilization for Mental Health-Related Visits

“…4 Previous review of our PED utilization pattern over the same study period found no significant changes in acuity distribution using the CTAS. 35 This would suggest that the observed trends in CTAS scores among mental health-related visits likely reflect a change in acuity level distribution rather than alterations in our triaging system or practice. Future studies should address the appropriateness of the CTAS for triaging mental health-related visits to the PED, as it is possible that this tool assesses urgency better than severity, particularly when evaluating chronic conditions.…”

Frequent users of the pediatric emergency department

“…Of note, a Canadian retrospective study on PED use in British Columbia reports that during a period where annual PED visits increased by 30%, visits triaged CTAS 1 and CTAS 3 remained constant (<10% increase), whereas CTAS 2 doubled, CTAS 4 increased by 30%, and CTAS 5 nearly quadrupled. 29 We identified that 4.7% of our population had five or more visits to the PED. This group of patients accounted for 16.6% of the total ED visits.…”

“…The number of visits at a Canadian pediatric hospital ED between 2002 and 2011 increased by 30%. 2 The increased use of ED services is recognized as a contributor to crowding. Other factors include delays in patient transfer from the ED, limited primary care access, and ED staff training limitations.…”

“…Other factors include delays in patient transfer from the ED, limited primary care access, and ED staff training limitations. 2 ED crowding can be defined as a situation where the need for emergency services exceeds the available resources for patient care 3 and can lead to compromised quality and access to health care. 4 Improvement in adult ED crowding has been associated with decreased mortality rate among admitted patients, 5 and ED crowding has been associated with increased costs, adverse outcomes, and overflow in hospital.…”

The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study

“…primary cause of overcrowding in general emergency departments, increasing visit volumes and operational inefficiencies appear to drive overcrowding in pediatric emergency departments. 11,12 Studies of overcrowding in pediatric emergency departments have identified important effects on quality of care, including delays in timely use of pain assessment scores for injuries, antibiotic administration for febrile neonates, analgesia for sickle cell crises or long bone fracture, and timely treatment of asthma. [13][14][15] Evidence supporting an association between measures of crowding in the pediatric emergency department and patient outcomes or impact on health care use, however, is lacking.…”