Predicting the impact on workload with the application of inpatient clinical review criteria into a paediatric emergency department

Abstract

Inpatient paediatric clinical observation charts that have predefined physiological criteria, which when reached might generate a mandatory medial review, are to be introduced into EDs in New South Wales. The present study estimated the increased workload of introducing these charts. The present study was carried out in the ED of The Children's Hospital at Westmead, Sydney, Australia. All patients admitted directly to the inpatient wards or to the Emergency Medical Unit for a 2 week period in April 2010 were included. The last set of clinical observations prior to the child being transferred out of the ED were recorded. These data were compared to the review criteria defined by the observation charts. The primary outcome was a possible activation of a review. Secondary outcomes were an attempt to quantify the extra time in the ED required before the review would be completed and the patient would be ready for transfer. There were 1822 presentations. Two hundred and fifty-three were admitted to the wards and 109 to the Emergency Medical Unit. There were 126 possible activations. Fifty-seven (52%) of Emergency Medical Unit patients and 69 (28%) of ward patients met review criteria at the time of transfer. The review activations might have generated an extra 7060 min of additional workload. Individual units must decide where in the patient journey to introduce the charts for acute paediatric admissions based on the number of acute paediatric admissions and their severity as well as the availability and ability of staff to respond to calls.