scholarly journals The Effect of the COVID-19 Pandemic on the Pediatric Emergency Department Flow

2021 ◽  
pp. 1-25
Author(s):  
Andrea Rivera-Sepulveda ◽  
Timothy Maul ◽  
Katherine Dong ◽  
Kylee Crate ◽  
Talia Helman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Admission Rate ◽  
Severity Index ◽  
Pediatric Emergency ◽  
Cross Sectional Study ◽  
P Value ◽  
Pediatric Emergency Department ◽  
Cross Sectional ◽  
Chief Complaints

ABSTRACT Objective: To determine how the early stages of the COVID-19 pandemic affected the utilization of the Pediatric Emergency Department (PED). Methods: Cross-sectional study of PED visits during January through April, 2016-2020. Data included: total PED visits, emergency severity index (ESI), disposition, chief complaint, age (months), time from first Provider to Disposition (PTD), and PED length of stay (PED-LOS). P-value <0.01 was statistically significant. Results: In total, 67,499 visits were reported. There was a significant decrease in PED visits of 24-71% from March to April 2020. Chief complaints for fever and cough were highest in March 2020; while April 2020 had a shorter mean PED-LOS (from 158 to 123 minutes), an increase of admissions (from 8% to 14%), a decrease in ESI 4 (10%), and an increase in ESI 3 (8%) (p<0.001). There was no difference in mean monthly PTD time. Conclusions: Patient flow in the PED was negatively affected by a decrease in PED visits and increase in admission rate that may be related to higher acuity. By understanding the interaction between hospital processes on PEDs and patient factors during a pandemic, we are able to anticipate and better allocate future resources.

scholarly journals Under Prescription of Epinephrine to Medicaid Patients in the Pediatric Emergency Department

2019 ◽  
Vol 6 ◽  
pp. 2333794X1985496
Author(s):  
Sylvia Owusu-Ansah ◽  
Oluwakemi Badaki ◽  
Jamie Perin ◽  
Martha Stevens ◽  
Jennifer Anders ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Emergency ◽  
Cross Sectional Study ◽  
Considerable Proportion ◽  
Pediatric Emergency Department ◽  
Sectional Study ◽  
Cross Sectional ◽  
Adherence Data ◽  
Auto Injector ◽  
Medicaid Prescription

Objective. To describe pediatric Medicaid patients with pediatric emergency department (PED) visits for anaphylaxis who received epinephrine auto-injector (EAI) prescriptions in the ED versus those who did not; and to compare patients who filled their prescriptions versus those who did not. Methods. We conducted a cross-sectional study of Medicaid patients aged 0 to 21 years presenting to 2 PEDs, with symptoms meeting the National Institute of Allergy and Infectious Diseases criteria for anaphylaxis, between July 2012 and July 2014. Results. We identified 86 patients across the 2 hospitals with a confirmed diagnosis of anaphylaxis in the PED. Of these, 55 (64%, 95% confidence interval [CI] = 53% to 74%) received a prescription for an EAI during their ED visit. Forty-two (68%; 95% CI = 56% to 80%) received a prescription for EAI in Hospital 1 versus 13 (54%; 95% CI = 33% to 74%) in Hospital 2. Medicaid prescription fill rates were available for Hospital 1. Of the 42 who received an EAI prescription, 36 (86%; 95% CI = 75% to 96%) filled these prescriptions with Medicaid. Of the 20 (32%) out of 62 patients with anaphylaxis who did not receive prescriptions for an EAI, only 5 had previously filled prescriptions for epinephrine. Conclusion. Previous Medicaid patient prescription adherence data suggested that these patients would have a low EAI prescription fill rate. We found Medicaid patients who received prescriptions for an EAI after the ED visit for anaphylaxis filled them; however, a considerable proportion of anaphylaxis visits had no EAI prescription provided at discharge.

scholarly journals Pediatric emergency department; resource exhaustion and burden of work in a resource-constrained region.

2021 ◽  
Vol 62 (4) ◽  
pp. 110-116
Author(s):  
Hasanein Habeeb Ghali ◽  
Mustafa A. Al-Shafiei ◽  
Hayder M. Al-Musawi
Keyword(s):  
Emergency Department ◽  
Complete Blood Count ◽  
Hospital Setting ◽  
Pediatric Emergency ◽  
P Value ◽  
Pediatric Emergency Department ◽  
Cross Sectional ◽  
Chronic Respiratory Diseases ◽  
Resource Exhaustion ◽  
Tract Infections

Background: emergency care is well known as the care delivered in a hospital setting to any patient with unexpected, sudden, threatening reversible condition. In countries where health care is not optimum, this type of care represents the weakest element of the health system. Aims of the study: to figure out the main causes behind the admission in Pediatric Emergency Department (PED) of Children Welfare Teaching Hospital (CWTH) and the urgency of visits. Patients and methods: a cross sectional study retrospective analysis that was carried out in the PED of CWTH in Medical City, Baghdad. Five hundred visits for patients below the age of 14 years between August and November 2017 were enrolled in this study and their data were analyzed. Perceived urgency of the current visit was assessed and analyzed. Results: the mean age for the patients was 3 years. Males represent 239 patients (47.8%). Of the whole group, 110 patients with a range of hours (22.0%). The most common complaint recorded was fever in 175 patients (21.0%). The most common comorbidities recorded were chronic respiratory diseases in 10 patients. Complete blood count was ordered for 460 patients (92.0%). Strikingly, blood culture was recorded in 5 patients only (1.0%). Reviewing the patients’ files has shown that 381 patients (76.2%) were prescribed antibiotics during stay in PED. The diagnosis of the patients visiting the PED was documented in 252 (50.4%) patients’ files only. Lower respiratory tract infections were the most frequently recorded diagnosis in 41 patients (8.2%). 266 patients (53.2%) were shown to be urgent visits, while 234 of them (46.8%) were non-urgent visits. Most of the patients who have comorbidities were labeled as urgent patients (89.4%), with a significant statistical difference (P value 0.001). Most of the patients who presented with a duration of complaint of within hours (89.1%) were stratified as urgent cases. Noteworthy, the majority of the patients who did not receive antibiotic therapy were stratified to be urgent (74.7%), the p value was 0.0001. Considering the disposition of the patients, majority of the patient who were discharged home (61.2%) were stratified as non-urgent, while (38.8%) were urgent. Conclusions: The study identifies the critical pitfalls of improper documentation of the data in the PED. It also delineates the resource exhaustion from the non-urgent visits. This may call for the need of structured training of physicians in the PED to improve efficiency, and reduce the cost and expenses of each patients through reducing the investigations and this will improve the standards of service. Triage system should be implemented in CWTH PED.

scholarly journals Comparison of efficacy between levosalbutamol and levosalbutamol-ipratropum nebulization in mild to moderate childhood asthma

2019 ◽  
Vol 6 (5) ◽  
pp. 1952
Author(s):  
R. Ramanathan ◽  
B. Mahalakshmi
Keyword(s):  
Emergency Department ◽  
Flow Rate ◽  
Childhood Asthma ◽  
Ipratropium Bromide ◽  
Randomized Study ◽  
Airflow Obstruction ◽  
Pediatric Emergency ◽  
P Value ◽  
Pediatric Emergency Department ◽  
The Mean

Background: The objective of the study was to compare the efficacy between levosalbutamol and ipratropium combination over levosalbutamol nebulisation in reversing airflow obstruction and improve oxygenation, evaluated using the pulmonary asthma score, SaO2, and PEFR in mild and moderate asthma.Methods: A prospective, randomized, study was performed in RMMCH pediatric emergency department. Children between 6 and 12 years of age who presented with mild to moderate asthma exacerberations were enrolled in the study. They were randomly allocated into two different groups: one nebulised with levosalbutamol alone and another with addition of ipratropium bromide to levosalbutamol. Baseline Peak expiratory flow rate and Final absolute values or change from baseline 60-120 minutes after the inhalation are measured. Patients were evaluated using the pulmonary score.Results: After treatment there is improvement in the mean pulmonary asthma scores and PEFR percentage in A+B group than A group, but it is not statistically significant (p value >0.05). There is statistically significant improvement in pulmonary asthma score and PEFR in each of the groups after nebulisation and pulmonary asthma score has a sensitivity of 66.7% and 65.6% in diagnosing severity of asthma in relation to PEFR.

scholarly journals Adjacent Primary Care May Reduce Less Urgent Pediatric Emergency Department Visits

2020 ◽  
Vol 11 ◽  
pp. 215013272092627
Author(s):  
Julia Ellbrant ◽  
Jonas Åkeson ◽  
Helena Sletten ◽  
Jenny Eckner ◽  
Pia Karlsland Åkeson
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Patient Characteristics ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
University Hospital ◽  
Pediatric Emergency Department ◽  
Hospital Data ◽  
Cross Sectional ◽  
Ed Visits

Aims: Pediatric emergency department (ED) overcrowding is a challenge. This study was designed to evaluate if a hospital-integrated primary care unit (HPCU) reduces less urgent visits at a pediatric ED. Methods: This retrospective cross-sectional study was carried out at a university hospital in Sweden, where the HPCU, open outside office hours, had been integrated next to the ED. Children seeking ED care during 4-week high- and low-load study periods before (2012) and after (2015) implementation of the HPCU were included. Information on patient characteristics, ED management, and length of ED stay was obtained from hospital data registers. Results: In total, 3216 and 3074 ED patient visits were recorded in 2012 and 2015, respectively. During opening hours of the HPCU, the proportions of pediatric ED visits (28% lower; P < .001), visits in the lowest triage group (36% lower; P < .001), patients presenting with fever ( P = .001) or ear pain ( P < .001), and nonadmitted ED patients ( P = .033), were significantly lower in 2015 than in 2012, whereas the proportion of infants ≤3 months was higher in 2015 ( P < .001). Conclusions: By enabling adjacent management of less urgent pediatric patients at adequate lower levels of medical care, implementation of a HPCU outside office hours may contribute to fewer and more appropriate pediatric ED visits.

scholarly journals Improving Low-acuity Patient Flow in a Pediatric Emergency Department

2018 ◽  
Vol 3 (6) ◽  
pp. e122 ◽  
Author(s):  
Deena A. Berkowitz ◽  
Kathleen Brown ◽  
Sephora Morrison ◽  
Asha Payne ◽  
Jeannie Pettinichi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department
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