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Abstract

Background and aims: The Victorian Paediatric Emergency Transport Service (PETS) in Australia retrieves critically unwell children to tertiary paediatric hospitals. Children not requiring ICU care are initially admitted to the ED. Aims: We aim to describe this cohort, outline clinical care needs and process measures. Methods: A retrospective chart review of patients retrieved by PETS to the Royal Children’s Hospital (Melbourne, Australia) ED in 2012. Demographics, illness parameters and process measures were extracted. “Clinically suitable for ward” was determined from vital signs and interventions needed. Data are presented descriptively and related to length of stay (LOS). IRB approval was obtained. Results: 120 patients were transported to the ED. The most common diagnoses were asthma (18%), seizures (16%), croup (13%) and bronchiolitis (12%). Median age was 3.2 years. The median LOS was 3.5 hours (IQR 1.5–7.5). 88% were admitted to a ward, 8% to ICU and 4% discharged home. On arrival to ED, 64% were clinically suitable for immediate ward admission, but only 40% (26% overall) were transferred to the ward within 4 hours. Two-thirds of the 74% with LOS >4 hours were clinically suitable for ward admission at 4 hours. 22% stayed in ED >8 hours. Respiratory infections and physiological severity on arrival were associated with prolonged LOS; age, time of arrival were not. Conclusions: Many retrieval patients have excessive ED LOS, even though most were clinically stable. A proportion of retrieved patients receive prolonged periods of high-level care in ED. Pre-arrival coordination and decision-making of retrieval patients can be improved to decrease unnecessary ED delays.