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Identifying key metrics for reducing premature departure from the pediatric emergency department
Journal article   Open access   Peer reviewed

Identifying key metrics for reducing premature departure from the pediatric emergency department

Keith P Cross, Edward Gracely, Michelle D Stevenson and Charles R Woods
Academic emergency medicine, v 17(11), pp 1197-1206
Nov 2010
DOI: https://doi.org/10.1111/j.1553-2712.2010.00908.x
PMID: 21175518
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1111/j.1553-2712.2010.00908.xView
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze),  Open

Abstract

Humans Risk Factors Child, Preschool Infant Logistic Models Emergency Service, Hospital - statistics & numerical data Young Adult Health Services Needs and Demand Pediatrics - statistics & numerical data Adolescent Emergency Service, Hospital - utilization Child Length of Stay - statistics & numerical data Cohort Studies Databases, Factual
Approximately 2% to 5% of children presenting to pediatric emergency departments (PEDs) leave prior to a complete evaluation. This study assessed risk factors for premature departure (PD) from a PED to identify key metrics and cutoffs for reducing the PD rate. A 3-year cohort (June 2004-May 2007) of children presenting to a PED was evaluated. Children were excluded if they presented for psychiatric issues, were held awaiting hospital admission in the PED due to a lack of inpatient beds, were more than 21 years old, or died before disposition. Univariate analyses, multivariable logistic regression, and recursive partitioning were used to identify factors associated with PD. A fourth year of data (June 2007-May 2008) was used for validation and sensitivity analysis. There were 132,324 patient visits in the 3-year derivation data set with a 3.8% PD rate, and 45,001 visits in the fourth-year validation data set with a 4.3% PD rate. PDs were minimized when average wait time was below 110 minutes, concurrent PDs were fewer than two, and average length of stay (LOS) was less than 224 minutes in the derivation set, with similar results in the validation set. When these metrics were exceeded, PD rates were over 10% among low-acuity patients. These findings were robust across a broad range of assumptions during sensitivity analysis. The authors identified five key metrics associated with PD in the PED: average wait time, average LOS, acuity, concurrent PDs, and arrival rate. Operational cutoffs for these metrics, determined by recursive partitioning, may be useful to physicians and administrators when selecting specific interventions to address PDs from the PED.

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7 citations in Scopus

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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Emergency Medicine
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