14 The Impact of a Pediatric Emergency Department Designation System on Pediatric Injury Mortality Rates in Arizona

Abstract

Currently, access to optimal emergency care for children is affected by multiple barriers, including, lack of availability of equipment, appropriately trained staff, and timely transfer to definitive care. Fourteen states, including Arizona have developed a regional or statewide system for pediatric emergency care. These programs aim to provide well-defined standards mandating critical resources required to provide effective care for children. While pediatric verification programs are associated with greater pediatric preparedness, outcome data has been lacking to track the effects and patient-centered outcomes of implementing such systems. Our aim is to describe the pediatric injury mortality outcomes of implementing a pediatric designation system within Arizona. This was a cross-sectional study conducted using data from emergency department visits and inpatient hospitalizations between 2011 and 2014 using the Arizona Hospital Discharge Database. Facilities certified between 2011 and 2014 were included in the analysis. Primary outcome measures were the pediatric emergency department injury mortality rate pre and post-certification. All records prior to certification were included in the pre-certification group. Once facilities were certified, all subsequent records during the month of certification were moved into the post-certification group. The pediatric emergency department mortality rates were calculated by dividing the total of pediatric ED visits by the number of deaths for each group, multiplied by 100,000 to equal the pediatric emergency department mortality rate per 100,000 visits. Pediatric injury mortality in Arizona emergency departments varied from 39.8 deaths per 100,000 ED visits to 25.6 deaths per 100,000 ED visits in the pre-certification and post-certification groups, respectively. Comparing the certified emergency department’s pediatric mortality rate to the overall pediatric injury mortality rate demonstrated 25.6 deaths versus 35.5 deaths respectively. Analysis of the pediatric mortality rates per 1,000 hospitalizations in the time period before initiation of the designation program (2009-2011) to the time period following initiation of the program (2012-2014) demonstrated a greater rate difference between certified and non-certified hospitals post-certification (7.9 versus 10.2 and 10.8 versus 17.5; respectively). The Arizona emergency department pediatric designation system resulted in a decrease in pediatric injury mortality post certification. Institutional certification also resulted in a reduction of inpatient pediatric injury mortality when compared to the non-certified hospitals in the same time period.