Novel Use of a Children's Emergency Department Scoring System as a Marker of Resource Utilisation

Abstract

Objectives & BackgroundThe Paediatric Observation Priority Score is an acuity scoring tool made of physiological, historial and subjective components. It is designed to be used in Children's urgent care settings and aids identification of both the unwell child and those children who can safely be managed in the community. As part of a programme to ensure its validity and reliability this study tested its ability to be an indicator of departmental resource utilisation.Table 1Disposition of Children presenting by POPSPOPSTotal NumberHomeRe-directed/Followed-upAdmitted029818547661–2346210301063–4196987915–663172447–82221189+11109Total93651387334MethodsSince its inception, prospective data has been collected by the Emergency Department (ED) at Leicester Royal Infirmary with regards to initial triage POPS, diagnosis and management in ED, and eventual disposition in the department. From this data, we isolated 936 presentations to ED over a small time frame. All children were aged 0–15 years. We analysed the initial POPS on presentation of these patients as a function of the investigations and interventions they went on to receive whilst in ED.ResultsPOPS scores range from 0 to 16. 298 of the 936 (31.8%) patients had an initial POPS of 0, and with 89.7% (840/936) having a POPS of 4 or less on presentation (Table 1). Grouping investigations and interventions together, patients with a POPS of 0 had on average 0.85 interventions per person. The average number of interventions per person increased in a linear fashion with increasing acuity as demonstrated by increasing POPS (Figure 1). Patients with a total POPS of 9 or above had on average 2.45 interventions per person. Chest X-ray, paracetamol and nebuliser administration, oral fluid challenge and intravenous antibiotic prescription all demonstrate a linear relationship between increased resource consumption and increasing clinical acuity.ConclusionPOPS demonstrates good correlation between acuity on presentation to the ED and the clinical requirement for investigation and intervention. This confirms the interval validity of the system although it is not suprising those children who are most unwell will require the most intervention. As POPS may provide a means of predicting likely resource consumption of children in ED at the point of assessment its utility to both senior decision makers and managers is apparent. Over time a model for resources utilisation which may aid and support service investment decisions could be developed.Figure 1CAU=Admitted, UCC=Redirected or Followed Up.

Changes to a Shift Reporting Sheet on a Critical Care Unit—Nurse Perceptions and Lessons Learned

“…Changing to a standardized format using a charting by exception style was identified as a method to improve accuracy, bedside nurse perception, and timely completion of forms. 1 , 8 , 9 …”