Pediatric emergency department overcrowding and impact on patient flow outcomes

Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Academic Emergency Medicine (Impact Factor: 2.2). 10/2008; 15(9):832-7. DOI: 10.1111/j.1553-2712.2008.00224.x
Source: PubMed

ABSTRACT Understanding the impact of overcrowding in pediatric emergency departments (PEDs) on quality of care is a growing concern. Boarding admitted patients in the PED and increasing emergency department (ED) visits are two potentially significant factors affecting quality of care.
The objective was to describe the impact ED boarding time and daily census have on the timeliness of care in a PED.
Pediatric ED boarding time and daily census were determined each day from July 2003 to July 2007. Outcome measures included mean length of stay (LOS), time to triage, time to physician, and patient elopement during a 24-hour period.
For every 50 patients seen above the average daily volume of 250, LOS increased 14.8 minutes, time to triage increased 6.6 minutes, time to physician increased 18.2 minutes, and number of patient elopements increased by three. For each increment of 24 hours to total ED boarding time, LOS increased 7.6 minutes, time to triage increased 0.6 minutes, time to physician increased 3 minutes, and number of patient elopements increased by 0.6 patients.
ED boarding time and ED daily census show independent associations with increasing overall LOS, time to triage, time to physician, and number of patient elopements in a PED.

  • [Show abstract] [Hide abstract]
    ABSTRACT: This report provides a summary of best practices for improving flow, reducing waiting times, and improving the quality of care of pediatric patients in the emergency department. Copyright © 2015 by the American Academy of Pediatrics.
    Pediatrics 01/2015; 135(1):e273-83. DOI:10.1542/peds.2014-3425 · 5.30 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Although increasing staff numbers during shifts when emergency department (ED) crowding is severe can help meet patient demand, it remains unclear how different types of added staff, particularly junior residents, may affect crowding. Methods: To identify associations between types of staff and ED crowding, we conducted a cross-sectional, single-center study in the ED of a large, teaching hospital in Japan between January and December 2012. Patients who visited the ED during the study period were enrolled. We excluded (1) patients previously scheduled to visit the ED, and (2) neonates transferred from other hospitals. During the study period, 27,970 patients were enrolled. Types of staff analyzed were junior (first and second year) residents, senior (third to fifth year) residents, attending (board-certified) physicians, and nurses. A generalized linear model was applied to length of ED stay for all patients as well as admitted and discharged patients to quantify an association with the additional staff. Results: In the model, addition of one attending physician or senior resident was associated with decreased length of ED stay for total patients by 3.88 or 1.64 minutes, respectively (95% CI, 2.20-5.56 and 0.81-2.48 minutes); while additional nursing staff had no association. Surprisingly, however, one additional junior resident was associated with prolonged length of ED stay for total patients by 0.97 minutes (95% CI 0.37-1.57 minutes) and for discharged patients by 1.01 minutes (95% CI 0.45-1.59 minutes). Conclusion: Staffing adjustments aimed at alleviating ED crowding should focus on adding more senior staff during peak-volume shifts.
    PLoS ONE 11/2014; 9(11):e110801. DOI:10.1371/journal.pone.0110801 · 3.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Overcrowding at pediatric emergency departments (EDs) may result in delayed clinical management and higher risks of medical error. This study was designed to prospectively evaluate what parents of sick children seek emergency care for and how these patients are being assessed and managed. Patients aged 0 to 17 years seeking ED care at an urban Swedish university hospital, from 8 AM to 9 PM on 25 consecutive days, were included. Clinical urgency and further level of medical care were determined by experienced nurses based on individual clinical signs and vital parameters. Information on presenting problem, medical priority, gender, age, waiting time, day of week, time of day, and further management was recorded. Among 1057 included children, two thirds were assessed by physicians, whereas one third were referred directly by nurses for other ED (n = 54) or primary care (n = 114), or sent home with medical advice (n = 176), more often during evenings and weekends. Of primarily referred patients, 7.6% returned within 72 hours, and three of them were admitted. Young infants, patients with respiratory or neurological problems, and sicker patients with fever or infections were mainly assessed by physicians, within desired priority time. More than one fourth of pediatric ED patients might rapidly, appropriately, and safely be referred for primary care or sent home by experienced pediatric nurses soon after arrival, thereby facilitating management of urgent and more appropriate patients. Evaluations by physicians were primarily required in young infants and for urgent medical conditions demanding qualified pediatric skills.


Available from