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Emergency department crowding negatively influences outcomes for children presenting with asthma: a population-based retrospective cohort study.
Pediatr Res. 2021 02; 89(3):679-685.PR

Abstract

BACKGROUND

Emergency department (ED) crowding may delay assessment and management and compromise outcomes. The association between the crowding metric time to physician initial assessment (PIA) and outcomes for children presenting for acute asthma is examined.

METHODS

A population-based retrospective cohort of all presentations to 18 high-volume EDs during 2010-2014 in Alberta, Canada was created. Hourly, facility-specific median PIAs were calculated. Physician claims and hospitalizations data were linked for children (2-17 years) presenting for asthma.

RESULTS

Twenty-five thousand three hundred and eighty-three presentations (16,053 children) were made for asthma. Crowding was common in all hospitals and affected PIA more for lower acuity presentations. For every 1-h increase in median facility PIA, the individual-level PIA increased by 13 min (95% CI: 12, 14) for high, 43 min (95% CI: 42, 44) for moderate, and 60 min (95% CI: 58, 61) for the low acuity groups, when adjusted by predictors. Similarly, length of stay increased by 6, 36, and 45 min for the high, moderate, and low acuity groups, respectively. Increased PIA resulted in more departures prior to completion of care for the lower acuity groups.

CONCLUSIONS

Crowding adversely affects short-term outcomes of less ill children more than those who are more ill. When EDs experience increased crowding, care to patients with asthma is delayed; effective strategies to reduce crowding and delays to care are urgently needed.

IMPACT

For children presenting to EDs for asthma, increased time to physician initial assessment adversely affects short-term outcomes of patients with less severe presentations to a greater extent compared to those who are most severe. Times to physician initial assessment are below recommended benchmarks; however, delays in care exist that impact LOS, odds of admission, and premature patient departures. Pediatric patients with severe asthma are seen quickly and their outcomes are excellent. Since crowding adversely affects short-term outcomes of pediatric patients with asthma, efforts to reduce ED crowding and assess patients with asthma in a more timely manner are needed.

Authors+Show Affiliations

Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada. School of Public Health, University of Alberta, Edmonton, AB, Canada.School of Public Health, University of Alberta, Edmonton, AB, Canada. Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. rhonda.rosychuk@ualberta.ca.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32344424

Citation

Sagaidak, Sofia, et al. "Emergency Department Crowding Negatively Influences Outcomes for Children Presenting With Asthma: a Population-based Retrospective Cohort Study." Pediatric Research, vol. 89, no. 3, 2021, pp. 679-685.
Sagaidak S, Rowe BH, Ospina MB, et al. Emergency department crowding negatively influences outcomes for children presenting with asthma: a population-based retrospective cohort study. Pediatr Res. 2021;89(3):679-685.
Sagaidak, S., Rowe, B. H., Ospina, M. B., & Rosychuk, R. J. (2021). Emergency department crowding negatively influences outcomes for children presenting with asthma: a population-based retrospective cohort study. Pediatric Research, 89(3), 679-685. https://doi.org/10.1038/s41390-020-0918-2
Sagaidak S, et al. Emergency Department Crowding Negatively Influences Outcomes for Children Presenting With Asthma: a Population-based Retrospective Cohort Study. Pediatr Res. 2021;89(3):679-685. PubMed PMID: 32344424.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergency department crowding negatively influences outcomes for children presenting with asthma: a population-based retrospective cohort study. AU - Sagaidak,Sofia, AU - Rowe,Brian H, AU - Ospina,Maria B, AU - Rosychuk,Rhonda J, Y1 - 2020/04/28/ PY - 2020/01/16/received PY - 2020/04/08/accepted PY - 2020/04/07/revised PY - 2020/4/29/pubmed PY - 2020/4/29/medline PY - 2020/4/29/entrez SP - 679 EP - 685 JF - Pediatric research JO - Pediatr Res VL - 89 IS - 3 N2 - BACKGROUND: Emergency department (ED) crowding may delay assessment and management and compromise outcomes. The association between the crowding metric time to physician initial assessment (PIA) and outcomes for children presenting for acute asthma is examined. METHODS: A population-based retrospective cohort of all presentations to 18 high-volume EDs during 2010-2014 in Alberta, Canada was created. Hourly, facility-specific median PIAs were calculated. Physician claims and hospitalizations data were linked for children (2-17 years) presenting for asthma. RESULTS: Twenty-five thousand three hundred and eighty-three presentations (16,053 children) were made for asthma. Crowding was common in all hospitals and affected PIA more for lower acuity presentations. For every 1-h increase in median facility PIA, the individual-level PIA increased by 13 min (95% CI: 12, 14) for high, 43 min (95% CI: 42, 44) for moderate, and 60 min (95% CI: 58, 61) for the low acuity groups, when adjusted by predictors. Similarly, length of stay increased by 6, 36, and 45 min for the high, moderate, and low acuity groups, respectively. Increased PIA resulted in more departures prior to completion of care for the lower acuity groups. CONCLUSIONS: Crowding adversely affects short-term outcomes of less ill children more than those who are more ill. When EDs experience increased crowding, care to patients with asthma is delayed; effective strategies to reduce crowding and delays to care are urgently needed. IMPACT: For children presenting to EDs for asthma, increased time to physician initial assessment adversely affects short-term outcomes of patients with less severe presentations to a greater extent compared to those who are most severe. Times to physician initial assessment are below recommended benchmarks; however, delays in care exist that impact LOS, odds of admission, and premature patient departures. Pediatric patients with severe asthma are seen quickly and their outcomes are excellent. Since crowding adversely affects short-term outcomes of pediatric patients with asthma, efforts to reduce ED crowding and assess patients with asthma in a more timely manner are needed. SN - 1530-0447 UR - https://www.unboundmedicine.com/medline/citation/32344424/Emergency_department_crowding_negatively_influences_outcomes_for_children_presenting_with_asthma:_a_population_based_retrospective_cohort_study_ L2 - https://doi.org/10.1038/s41390-020-0918-2 DB - PRIME DP - Unbound Medicine ER -
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