Title

The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study.

Authors

Quynh Doan
Hubert Wong
Garth Meckler
David Johnson
Antonia Stang
Andrew Dixon
Scott Sawyer
Tania Principi
April J Kam
Gary Joubert, Western University
Jocelyn Gravel
Mona Jabbour
Astrid Guttmann

Document Type

Article

Publication Date

6-10-2019

Journal

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne

Volume

191

Issue

23

First Page

627

Last Page

627

URL with Digital Object Identifier

https://doi.org/10.1503/cmaj.181426

Abstract

BACKGROUND:
Emergency department overcrowding has been associated with increased odds of hospital admission and mortality after discharge from the emergency department in predominantly adult cohorts. The objective of this study was to evaluate the association between crowding and the odds of several adverse outcomes among children seen at a pediatric emergency department.

METHODS:
We conducted a retrospective cohort study involving all children visiting 8 Canadian pediatric emergency departments across 4 provinces between 2010 and 2014. We analyzed the association between mean departmental length of stay for each index visit and hospital admission within 7 days or death within 14 days of emergency department discharge, as well as hospital admission at index visit and return visits within 7 days, using mixed-effects logistic regression modelling.

RESULTS:
A total of 1 931 465 index visits occurred across study sites over the 5-year period, with little variation in index visit hospital admission or median length of stay. Hospital admission within 7 days of discharge and 14-day mortality were low across provinces (0.8%-1.5% and < 10 per 100 000 visits, respectively), and their association with mean departmental length of stay varied by triage categories and across sites but was not significant. There were increased odds of hospital admission at the index visit with increasing departmental crowding among visits triaged to Canadian Triage and Acuity Scale (CTAS) score 1-2 (odds ratios [ORs] ranged from 1.01 to 1.08) and return visits among patients with a CTAS score of 4-5 discharged at the index visit at some sites (ORs ranged from 1.00 to 1.06).

INTERPRETATION:
Emergency department crowding was not significantly associated with hospital admission within 7 days of the emergency department visit or mortality in children. However, it was associated with increased hospital admission at the index visit for the sickest children, and with return visits to the emergency department for those less sick.

Notes

Also available open access in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne at https://doi.org/10.1503/cmaj.181426