Abstract
BackgroundDedicated pediatricians in emergency departments (EDs) may be beneficial, though no previous studies have assessed the related costs and benefits/harms. We aimed to evaluate the net benefits and costs of dedicated emergency pediatricians in a pediatric ED.MethodsCost-consequences analysis of visits to a pediatric ED of a tertiary hospital. Two pediatric ED Medical Teams (MT) were compared: MT-A (May–September 2012), with general pediatrics physicians only; and MT-B (May–September 2013), with emergency dedicated pediatricians. The main outcomes analyzed were relevant clinical outcomes, patient throughput time and costs.ResultsWe included 8,694 children in MT-A and 9,417 in MT-B. Medication use in the ED increased from 42.3% of the children in MT-A to 49.6% in MT-B; diagnostic tests decreased from 24.2% in MT-A to 14.3% in MT-B. Hospitalization increased from 1.3% in MT-A to 3.0% in MT-B; however, there was no significant difference in diagnosis-related group relative weight of hospitalized children in MT-A and MT-B (MT-A, 0.979; MT-B, 1.075). No differences were observed in ED readmissions or in patients leaving without being seen by a physician. The patient throughput time was significantly shorter in MT-B, with faster times to first medical observation. Within the cost domains analyzed, the total expenditures per children observed in the ED were 16% lower in MT-B: 37.87 euros in MT-A; 31.97 euros in MT-B.ConclusionThe presence of dedicated emergency pediatricians in a pediatric ED was associated with significantly lower waiting times in the ED, reduced costs, and similar clinical outcomes.
Highlights
Medication use in the emergency departments (EDs) increased from 42.3% of the children in Medical Teams (MT)-A to 49.6% in MT-B; diagnostic tests decreased from 24.2% in MT-A to 14.3% in MT-B
Hospitalization increased from 1.3% in MT-A to 3.0% in MT-B; there was no significant difference in diagnosis-related group relative weight of hospitalized children in MT-A and MT-B (MT-A, 0.979; MT-B, 1.075)
No differences were observed in ED readmissions or in patients leaving without being seen by a physician
Summary
There are different models of pediatric emergency care worldwide.[1,2,3,4,5] Differences in facilities, age of admission, triage, referral or physician’s qualification may influence the outcomes in pediatric emergency care.[6,7,8]Over the last decade, pediatric emergency medicine has been progressively recognized, [9,10] first in the United States, Canada, [11, 12] and Australia and later in Europe, [13, 14] where it is regarded as a subspecialty by the European Academy of Pediatrics.[15]. Specific performance measures for pediatric emergency care were identified and should be used to assess efficiency of pediatric emergency care systems.[16, 17] Evidence-based guidelines are required to standardize pediatric emergency care models and clinical practice procedures. In this context, analysis of the net benefits and related costs of dedicated emergency pediatricians teams are of major importance. Cost-consequences analysis is a comprehensive economic evaluation that fits the society’s health values, [18] and can be applied to the assessment of dedicated emergency pediatricians in ED.
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