No abstract

No abstract

Abstract. Objective: Children show a consistent pattern of ED use, with the majority of patients presenting during the late afternoon and evening hours. This study evaluated whether such a diurnal pattern also exists for critically ill children and the implications of such a presentation pattern on ED staffing. Methods: A review was performed of the ED diagnoses and times of presentation for children less than 12 years of age at 28 nonpediatric hospitals over the six-year period from July 1990 to October 1996. In addition to total ED pediatric visits, a subset of critically ill children (CIC) were identified as those with an ED diagnosis of: meningitis, cardiac arrest, diabetic ketoacidosis, status epilepticus, meningococcemia, or epiglottitis, or those undergoing endotracheal intubation in the ED. A second group of non-critically ill children (NCIC) was composed of children with an ED diagnosis of otitis media, tonsillitis, or pharyngitis. Data collected on each patient included age, diagnosis, site of care, and time of service. Presentation patterns for all three groups were compared for time of day, with statistical analysis through chi-square, ANOVA, and Spearman's rho correlation. Results: A total of 409,820 pediatric ED visits were examined, with 688 CIC children and 28,344 NCIC identified. Presentation patterns for NCIC visits mirrored those of the total pediatric population, with the traditional increase in the late afternoon and evening hours (correlation 0.96). CIC presented much more erratically, with a distribution spread more uniformly throughout the day compared with the total pediatric population (correlation 0.72). Thirty-seven percent of CIC presented during the evening hours of 16:00 to 24:00, compared with 49% for NCIC and 53% for the total pediatric population, while 22% of CIC presented from 24:00 to 08:00 compared with only 13% of NCIC and 10% of total pediatric patients (p < 0.001). Conclusion: Critically ill children present more uniformly throughout the day and do not have the same presentation patterns as ambulatory children. ED staffing should reflect this difference and not focus pediatric ED services simply on hours of peak pediatric visits. Key words: children; emergency department; presentation patterns; children; critically ill children. ACADEMIC EMERGENCY MEDICINE 1999; 6:906-910 C HILDREN show a consistent pattern of ED utilization, with increased presentations in the late afternoon and evening hours. Such presentation patterns are evident for the overall pediatric ED population, although they have never been demonstrated to exist for all subsets of children. This study was undertaken to determine whether ED utilization by critically ill children (CIC) mirrors that of ambulatory non-critically ill children (NCIC). A unique CIC presentation pattern would have implications for EDs that selec- METHODS StudyDesign. An emergency medicine (EM) database of patient visits was used to identify patterns in timing of pediatric ED utilization. Information on patient age, diagnosis, time of...

The Universal Billing Code of 1992 (UB-92) is a standard database used by hospitals to generate itemized charges for patient visits. This study examined the use of UB-92 information to monitor emergency department performance improvement projects. UB-92 data were used to determine whether urine tests had been ordered for emergency department patients. A population of patients at low risk for requiring a urine culture was defined as discharged female patients between 16 and 60 years of age undergoing a urinalysis as part of their emergency department treatment during a 10-month period. Based on UB-92 data, only a total of 2,138 patients were identified who met the study's low-risk criteria. Recommendations for the optimum use of these tests were presented to the emergency physicians as part of departmental performance improvement activities. Additional logistical problems associated with the procedure for ordering this test were identified and corrected as part of this project. After an additional 5-month period, a second analysis of the entire 15 months of UB-92 data was performed. Prior to physician notification, 41.6% of low-risk patients underwent both a urinalysis and a urine culture and sensitivity in the emergency department. In the 5-month follow-up period, the percentage of patients undergoing both tests decreased 18% to only 23%.