Factors associated with prolonged stay in a pediatric emergency observation unit of an urban tertiary children's hospital in China

Length of stay and associated factors among pediatric patients in the pediatric emergency unit of the Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia

BACKGROUND

Length of stay in the emergency department is used as a quality indicator to gauge the overall efficiency of emergency care. The performance measure was used to evaluate the quality of care provided in the emergency department.

OBJECTIVE

To assess the length of stay and associated factors among pediatric patients admitted to the pediatric emergency unit of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia.

METHODS

An institution-based prospective cross-sectional study design was employed. A systematic random sampling technique was used to select the study participants. Data were collected via semi-structured, interviewer-administered questionnaires and chart reviews. Analysis was performed via the Statistical Package for Social Science software version 27. Binary logistic regression analysis was conducted to identify variables associated with the length of stay. The study was conducted in the Pediatric Emergency Unit of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, from March 15 to April 15, 2023.

RESULTS

A total of 268 patients participated in the study, with a response rate of 97.81%. The majority of the participants were male (157, 58.6%), with a median age of 3 years. The study revealed that 180 participants (67.2%) experienced a prolonged length of stay. The variables significantly associated with prolonged length of stay included residency (AOR = 2.04, CI: 1.03, 4.025), triage category (AOR = 3.25, CI: 1.08, 5.974), number of investigations (AOR = 2.381, CI: 1.038, 5.462), and waiting for imaging (AOR = 4.230, CI: 1.638, 10.93).

CONCLUSION

Many pediatric patients stayed in the emergency room for more than 24 h because of factors such as residency, triage category, number of investigations, and the need for imaging. To address this, we recommend streamlining triage processes, increasing imaging resources, providing additional staff training, developing integrated care pathways, and advocating for policy changes to increase emergency room efficiency and improve patient outcomes.

Length of stay in the emergency department and its associated factors among pediatric patients attending Wolaita Sodo University Teaching and Referral Hospital, Southern, Ethiopia

BACKGROUND

Globally, there is an increase in the need for emergency department visits, which is exceptionally high in pediatric patients, resulting in longer lengths of stay, which is a global challenge and a hospital bottleneck that increases the risk of patient morbidity and mortality while also lowering satisfaction.

OBJECTIVE

This study aimed to assess the length of stay and associated factors in the pediatric emergency department at Wolaita Sodo University Hospital in 2021.

METHODS

An institution-based cross-sectional investigation was undertaken from March 15 to May 15, 2021. The 422 study participants were chosen using a systematic sampling procedure. The data were collected using semi-structured interviewer-administered questionnaires and chart reviews. Epi Data version 4.6 was used to enter the data, while SPSS version 26 was used to analyze it. With a 95% confidence interval, descriptive statistics were used to describe the prevalence, pediatrics, and emergency department duration of stay. The factors related to the length of stay were identified using bivariable and multivariable logistic regression analysis. On the AOR, a significant level was proclaimed when the p-value was less than 0.05, and the confidence interval was less than 95%.

RESULTS

The proportion of prolonged pediatric emergency department length of stay was 79.70% (95% CI; 75.7, 83.6). Nighttime arrival [AOR = 3.19, 95% CI (1.14, 8.98)], weekend arrival [AOR = 4.25, 95% CI (1.49, 5.35)], not receiving ordered medication in the hospital [AOR = 2.05, 95% CI (1.04, 4.03)], orange triage category [AOR = 4.01, 95% CI (1.60, 10.05)], and duration of pain 13-24 h [AOR = 0.29, 95% CI (0.89,0.98)], were significantly associated with length of stay.

CONCLUSION

The percentage of children who stayed in the pediatric emergency department for an extended period was high. Policymakers should implement evidence-based care, maximize existing resources, provide equal access to care and high-quality care, and make pediatric emergency departments more accessible and operationally efficient.

Real-Time Measurement of Crowding in Pediatric Emergency Department: Derivation and Validation Using Consensual Perception of Crowding (SOTU-PED)

ABSTRACT

Our study aimed to develop and validate a real-time crowding composite scale for pediatric emergency department (PED). The study took place in one teaching PED for 2 months. The outcome was the perception of crowding evaluated by triage nurses and pediatricians on a 10-level Likert scale. Triage nurses evaluated crowding at each moment of a child's admission and pediatrician at each moment of a child's discharge. The outcome was the hourly mean of all evaluations of crowding (hourly crowding perception). For analysis, originally, we only selected hours during which more than 2 nurses and more than 2 pediatricians evaluated crowding and, moreover, during which evaluations were the most consensual. As predictors, we used hourly means of 10 objective crowding indicators previously selected as consensual in a published French national Delphi study and collected automatically in our software system. The model (SOTU-PED) was developed over a 1-month data set using a backward multivariable linear regression model. Then, we applied the SOTU-PED model on a 1-month validation data set. During the study period, 7341 children were admitted in the PED. The outcome was available for 1352/1392 hours, among which 639 were included in the analysis as "consensual hours." Five indicators were included in the final model, the SOTU-PED (R2 = 0.718). On the validation data set, the correlation between the outcome (perception of crowding) and the SOTU-PED was 0.824. To predict crowded hours (hourly crowding perception >5), the area under the curve was 0.957 (0.933-0.980). The positive and negative likelihood ratios were 8.16 (3.82-17.43) and 0.153 (0.111-0.223), respectively. Using a simple model, it is possible to estimate in real time how crowded a PED is.

The "two-step four-level+ " pediatric triage method in a medical center in Southern China

PURPOSE

Because the quality of medical resources is extremely uneven across China, it is nearly impossible to implement a unified emergency triage program. The aim of the study is to examine triage using the "two-step four-level⁺ " triage model in a hospital in Southern China, with an emphasis on hand, foot, and mouth disease.

DESIGN AND METHODS

This was a retrospective study of all patients seen in the pediatric emergency room (ER) between January 1, 2012 and December 31, 2018, at the Guangzhou Women and Children's Medical Center. The "two-step and four-level⁺ " was manually implemented in 2012, and an electronic triage system was developed and applied since 2015. Emergency quality control indicators were analyzed.

RESULTS

There were 645,473 patients triaged at the pediatric ER between January 1, 2015 and December 31, 2018. After the first step, 17,444 patients were classified as unstable, including 6546 (1.01%) Level I patients, 10,898 (1.69%) Level II patients, 210,368 (32.5%) Level III patients, and 417,661 (64.8%) Level IV patients. After triage implementation, the stay time of the patient in the pediatric ER decreased each year (all p < .05) and shortened to 20.3 ± 2.2 h in 2018. Compared with 2012-2014, the mortality of 2015-2018 decreased by 21.1%, the rate of unexpected resuscitation was 0%, and the complaints of overcrowding decreased (all p < .05).

PRACTICE IMPLICATIONS

This "two-step four-level⁺ " triage method can improve the medical care quality of pediatric ER in China.

Protocolized emergency department observation care improves quality of ischemic stroke care in Haiti

INTRODUCTION

In many low-income countries, Emergency Medicine is underdeveloped and faces many operational challenges including emergency department (ED) overcrowding and prolonged patient length of stays (LOS). In high-resource settings, protocolized ED observation unit (EDOU) care reduces LOS while preserving care quality. EDOUs are untested in low-income countries. We evaluate the effect protocolized EDOU care for ischemic stroke on the quality and efficiency of care in Haiti.

METHODS

We performed a prospective cohort study of protocolized observation care for ischemic stroke at a Haitian academic hospital between January 2014 and September 2015. We compared patients cared for in the EDOU using the ischemic stroke protocol (study group) to eligible patients cared for before protocol implementation (baseline group), as well as to eligible patients treated after protocol introduction but managed without the EDOU protocol (contemporary reference group). We analysed three quality of care measures: aspirin administration, physical therapy consultation, and swallow evaluation. We also analysed ED and hospital LOS as measures of efficiency.

RESULTS

Patients receiving protocolized EDOU care achieved higher care quality compared to the baseline group, with higher rates of aspirin administration (91% v. 17%, p < 0.001), physical therapy consultation (50% v. 9.6%, p < 0.001), and swallow evaluation (36% v. 3.7%, p < 0.001). We observed similar improvements in the study group compared to the contemporary reference group. Most patients (92%) were managed entirely in the ED or EDOU. LOS for non-admitted patients was longer in the study group than the baseline group (28 v. 19 h, p = 0.023).

CONCLUSION

Protocolized EDOU care for patients with ischemic stroke in Haiti improved performance on key quality measures but increased LOS, likely due to more interventions. Future studies should examine the aspects of EDOU care are most effective at promoting higher care quality, and if similar results are achievable in patients with other conditions.

The associations between injury mechanism and extended hospital stay among pediatric patients: findings from a trauma Center in Saudi Arabia

BACKGROUND

A hospitalized patient's length of stay (LOS) can have a significant impact on the performance and operating costs of a healthcare facility. Among pediatric patients, traumatic injuries are common causes of emergency room visits and hospitalizations. In Saudi Arabia, little is known about the burden of pediatric traumas on population health and the healthcare facilities. Therefore, the aim of this study was to investigate the associations between traumatic pediatric injury mechanisms and extended LOS in a trauma center.

METHODS

Data was obtained from the trauma registry. From 2001 to 2018, trauma patients between the ages of 0 and 18 years old with LOSs of > 0 days were analyzed. The independent variable was the injury mechanism, which was classified as follows: falls, burns, drowning, motor vehicle collisions, motorcycle collisions, pedestrian, and intentional injuries. The dependent variable was an extended LOS defined as ≥21 days. A multivariate logistic regression analysis was used to evaluate the associations between the injury mechanisms and an extended LOS.

RESULTS

A total of 5563 pediatric patients were included in this study. Of those, 774 (14%) had extended LOSs. Those patients with extended LOSs suffered more severe injuries than those with short hospital stays as measured by the Injury Severity Score (mean scores: 15.4 vs. 6.8, p < 0.01), the Glasgow Coma Scale score (mean scores: 10.4 vs, 14.0, p < 0.01), and the Revised Trauma Score (mean scores: 9.9 vs. 11.0, p < 0.01). Approximately one half of the patients with extended LOSs were admitted due to motor vehicle injuries. In addition, those patients were almost five times more likely to have extended LOSs than the patients who suffered fall injuries (odds ratio: 4.8, 95% confidence interval: 3.2-7.1).

CONCLUSIONS

Based on the study results, motor vehicle injuries were significantly associated with extended hospitalizations. Prevention is instrumental for reducing healthcare utilization; therefore, these findings call for public health professionals and policymakers to plan, design, and implement preventive measures to reduce the traffic injury burden. In addition, increased traffic law enforcement, such as the use of car restraints, is warranted to reduce the preventable injuries and improve the overall population health.

Patient-level Factors and the Quality of Care Delivered in Pediatric Emergency Departments

OBJECTIVE

Quality of care delivered to adult patients in the emergency department (ED) is often associated with demographic and clinical factors such as a patient's race/ethnicity and insurance status. We sought to determine whether the quality of care delivered to children in the ED was associated with a variety of patient-level factors.

METHODS

This was a retrospective, observational cohort study. Pediatric patients (<18 years) who received care between January 2011 and December 2011 at one of 12 EDs participating in the Pediatric Emergency Care Applied Research Network (PECARN) were included. We analyzed demographic factors (including age, sex, and payment source) and clinical factors (including triage, chief complaint, and severity of illness). We measured quality of care using a previously validated implicit review instrument using chart review with a summary score that ranged from 5 to 35. We examined associations between demographic and clinical factors and quality of care using a hierarchical multivariable linear regression model with hospital site as a random effect.

RESULTS

In the multivariable model, among the 620 ED encounters reviewed, we did not find any association between patient age, sex, race/ethnicity, and payment source and the quality of care delivered. However, we did find that some chief complaint categories were significantly associated with lower than average quality of care, including fever (-0.65 points in quality, 95% confidence interval [CI] = -1.24 to -0.06) and upper respiratory symptoms (-0.68 points in quality, 95% CI = -1.30 to -0.07).

CONCLUSION

We found that quality of ED care delivered to children among a cohort of 12 EDs participating in the PECARN was high and did not differ by patient age, sex, race/ethnicity, and payment source, but did vary by the presenting chief complaint.

Emergency department use by paediatric patients in Lombardy Region, Italy: a population study

OBJECTIVES

To estimate the rate of paediatric attendance at emergency departments (EDs) in the Lombardy Region, Italy, and to determine the factors contributing to different patterns of use.

METHODS

By analysing healthcare administrative databases, ED attendance by 1.6 million youths <18 years old during 2012 in the Lombardy Region was assessed. The pattern of use was categorised based on the number of ED visits and level of emergency, defined by triage code and outcome of the visit. Logistic regression analyses were performed to identify the characteristics of access for non-urgent reasons and those of patients with frequent non-urgent access (≥4 accesses for non-urgent reasons only). A case-control study was carried out to compare healthcare resource use by children 1-5 years old who were 'frequent non-urgent users' with that of randomly selected controls, matched by age, gender, nationality and primary care physician.

RESULTS

During 2012, 440 284 (27%) of children and adolescents had at least one ED attendance, with trauma (26%) and respiratory tract infections (22%) as the most frequent diagnoses. In all, 533 037 (79%) accesses were for non-urgent reasons, and 12 533 (3% of the ED users) were frequent non-urgent users. Male gender (OR 1.12; 95% CI 1.08 to 1.17), preschool age (OR 3.14; 95% CI 2.98 to 3.31) and place of residence (OR 1.74; 95% CI 1.70 to 1.99) were associated with a higher risk of being a frequent non-urgent user. Moreover, a greater healthcare consumption was observed in this group.

CONCLUSIONS

One out of four children and adolescents attended the ED at least once per year, 3% of whom were frequent non-urgent users, with a high overall healthcare resource consumption.