Changes in practice patterns with the opening of a dedicated pediatric emergency department.

Abstract

Dedicated pediatric emergency departments (ED) staffed by pediatric emergency medicine physicians are becoming more common. We compared processes of care and outcomes before and after opening a dedicated pediatric ED. A before and after trial design was used to estimate whether there were any changes in ordering of laboratory tests, radiographic imaging, admission rates, ED length of stay (LOS), rates of left without being seen (LWBS) and patient satisfaction scores after opening a dedicated pediatric ED staffed by pediatric emergency medicine physicians. There were 34,961 pediatric patients; 16,311 (47%) presented before and 18,650 (53%) after opening the pediatric ED. Overall radiologic imaging decreased (42.5% vs. 39.3%; difference, 3.2%; 95% confidence interval [95% CI], 2.1%-4.2%) as did computed tomography (8.9% vs. 7.6%; difference, 1.2%; 95% CI, 0.7%-1.8%) but not magnetic resonance imaging. Laboratory testing decreased from 33.1% to 30.1% (difference, 3%; 95% CI, 2.1%-4.0%) of patients. Mean [SD] ED LOS (3.1 [2.5] vs. 2.8 [2.2] hours; difference, 0.36; 95% CI, 0.31-0.41) as well as the rate of LWBS (1.0% vs. 0.6%; difference, 0.4%; 95% CI, 0.2%-0.5%) also decreased. Admission rates (9.4% vs. 9.4%) and unscheduled return visits within 72 hours (3.2% vs. 3.5%) were unchanged. Mean (SD) monthly satisfaction scores increased from 81.3 (2.2) to 86.3 (2.2) (difference, 5; 95% CI, 3%-7%). Opening of a pediatric ED with pediatric emergency physicians was associated with decreases in ED LOS, rates of LWBS, general radiographic, and computed tomography imaging as well as laboratory testing, and increases in patient satisfaction scores. The clinical significance of these changes is unclear.