Patient‐level Factors and the Quality of Care Delivered in Pediatric Emergency Departments

Marcin, James P.; Romano, Patrick S.; Dayal, Parul; Dharmar, Madan; Chamberlain, James M.; Dudley, Nanette C.; Macias, Charles G.; Nigrovic, Lise E.; Powell, Elizabeth C.; Rogers, Alexander; Sonnett, Meridith; Tzimenatos, Leah; Andrews-Dickert, Rebecca; Borgialli, Dominic; Sidney, Erika; Casper, T. Charles; Dean, Jonathan; Kuppermann, Nathan

doi:10.1111/acem.13347

Cited by 7 publications

(4 citation statements)

References 38 publications

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“…Besides, it reduced the waiting period between the hospital admission and examination by a physician, along with a length of a hospital stay. Moreover, the proportion of patients who left the waiting room without doctor's examination declined by 50%, which improved their safety [3].…”

Section: Discussionmentioning

confidence: 99%

“…This situation is explained by the lack of clinical guidelines developed for management of emergency pathologies at the preclinical stage [2]. The number of patients admitted to emergency departments cannot be predicted with great precision; and only a fraction of those suffers from lifethreatening diseases or conditions requiring urgent care [3], and not all patients are in need of immediate medical care. Therefore, patients with severe pathologies and life-threatening injuries should be identified within minutes of their admission to emergency departments [4].…”

Section: Introductionmentioning

confidence: 99%

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2021

Russ Open Med J

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Medical sorting is aimed at assessment of disease severity and has to be carried out within a short time to determine the priorities for patient care and transportation to the most appropriate place for future treatment. The goal of this study was to provide an integrative review by analyzing the publications on the most common triage systems worldwide in order to select and implement the most reliable system at emergency departments. We searched for publications relevant to our comparative analysis in evidence-based medicine databases. A total of 1,740 literary sources were identified, of which 42 were selected for analysis. Comparative analysis of different triage systems may help implementing the most efficient system in Kazakhstan. The Emergency Severity Index is considered the most reliable and accurate tool used in international practice, and it could provide a basis for introduction of triage system at emergency departments in Kazakhstan.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Untitled

2021

Russ Open Med J

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“…The PECARN has developed and validated instruments to evaluate the quality of care delivery in pediatric care by using implicit review methods that can be used for diverse groups of patients . A recent study used this implicit review methods tool to look at patient‐level factors and the quality of care in 12 PECARN EDs and found that some chief complaint categories were associated with significantly lower than average quality of care, including fever (–0.65 points in quality, 95% CI = –1.24 to –0.06) and upper respiratory symptoms (–0.68 points in quality, 95% CI = –1.30 to –0.07) . The concern with current measures related to pediatric emergency care is the lack of a systematic and comprehensive approach.…”

Section: Conceptual Framework and Creation Of The Research Agendamentioning

confidence: 99%

A Research Agenda to Advance Pediatric Emergency Care Through Enhanced Collaboration Across Emergency Departments

Barata

Auerbach

Badaki-Makun

et al. 2018

Academic Emergency Medicine

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This subcommittee consisting of emergency medicine, pediatric emergency medicine, and quality improvement (QI) experts, as well as a patient advocate, identified main outcome gaps in the care of children in the emergency departments (EDs) in the following areas: variations in pediatric care and outcomes, pediatric readiness, and gaps in knowledge translation. The goal for this session was to create a research agenda that facilitates collaboration and partnering of diverse stakeholders to develop a system of care across all ED settings with the aim of improving quality and increasing safe medical care for children. The following recommended research strategies emerged: explore the use of technology as well as collaborative networks for education, research, and advocacy to develop and implement patient care guidelines, pediatric knowledge generation and dissemination, and pediatric QI and prepare all EDs to care for the acutely ill and injured pediatric patients. In conclusion, collaboration between general EDs and academic pediatric centers on research, dissemination, and implementation of evidence into clinical practice is a solution to improving the quality of pediatric care across the continuum.

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“…The number of patients visiting to emergency departments cannot be accurately predicted, and only some of them have life‐threatening diseases or require urgent treatment (Marcin et al., 2018), and but not all patients require immediate treatment (Pivina et al., 2021). Therefore, the triage process is essential to discriminate the priority of emergency patients visiting the emergency department (National Emergency Nurses Association, 2019).…”

Section: Introductionmentioning

confidence: 99%

Incidence of overtriage and undertriage and associated factors: A cross‐sectional study using a secondary data analysis

Jung,

2023

Journal of Advanced Nursing

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BackgroundImproving triage accuracy for accurate patient identification and appropriate resource allocation is essential. Little is known about the trend of triage accuracy, and factors associated with mistriage vary from study to study.AimTo identify incidence and risk factors of mistriage, such as overtriage and undertriage.DesignThis is a cross‐sectional study.MethodsThe data came from the National Emergency Department Information System database in 2016–2020. All patients 15 years and older visiting emergency departments in Korea were assessed for eligibility, and 20,641,411 emergency patients' data were used. Multivariable logistic regressions were conducted to confirm the associated factors with overtriage and undertriage compared to expected triage. Demographic characteristics, disease‐related signs and triage‐related factors were independent variables.ResultsExpected triage decreased from 96.8% in 2016 to 95.7% in 2020. Overtriage (0.5%–0.7%) and undertriage (2.4%–3.3%) increased. The occupation that performed triage the most (over 85%) was nurses. Associated factors with overtriage were demographic characteristics (40–64 age group, female), disease‐related signs (known disease, direct visit) and triage‐related factors (regional emergency medical centre). Risk factors to undertriage were disease‐related signs (systolic/diastolic blood pressure and pulse rates within normal range).ConclusionsWhile the acuity degree remained within the recommended range, the accuracy of triage decreased, and there was a gradual increase in mistriaged cases. Nurses have performed most of the triage and played a key role in expected triage. Associated factors with overtriage were demographic characteristics, disease‐related signs and triage‐related factors and risk factors to undertriage were disease‐related signs.Patient or public contributionNo patient or public contribution.Implications for the professionNurses should be aware of what factors are associated with mistriage and why the factors cause mistriage to improve the triage accuracy because they are responsible for the majority of the triage assessments.

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Patient‐level Factors and the Quality of Care Delivered in Pediatric Emergency Departments

Abstract: We found that quality of ED care delivered to children among a cohort of 12 EDs participating in the PECARN was high and did not differ by patient age, sex, race/ethnicity, and payment source, but did vary by the presenting chief complaint.

Cited by 7 publications

References 38 publications

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A Research Agenda to Advance Pediatric Emergency Care Through Enhanced Collaboration Across Emergency Departments

Incidence of overtriage and undertriage and associated factors: A cross‐sectional study using a secondary data analysis

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