System outcomes associated with a pediatric emergency department clinical decision unit

Karacabeyli, Derin; Meckler, Garth; Park, David K.; Doan, Quynh

doi:10.1017/cem.2018.57

Cited by 2 publications

(4 citation statements)

References 10 publications

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“…However, it has also been suggested that the introduction of the 4-hour target has increased (short-duration) admission rates, but consistent data are lacking 3. This leads to the discussion of a possible role of short-stay units, as these can potentially reduce ED length of stay as well as admissions 34…”

Section: Discussionmentioning

confidence: 99%

Diversity in the emergency care for febrile children in Europe: a questionnaire study

Borensztajn

Yeung

Hagedoorn

et al. 2019

bmjpo

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ObjectiveTo provide an overview of care in emergency departments (EDs) across Europe in order to interpret observational data and implement interventions regarding the management of febrile children.Design and settingAn electronic questionnaire was sent to the principal investigators of an ongoing study (PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management), www.perform2020.eu) in 11 European hospitals in eight countries: Austria, Germany, Greece, Latvia, the Netherlands, Slovenia, Spain and the UK.Outcome measuresThe questionnaire covered indicators in three domains: local ED quality (supervision, guideline availability, paper vs electronic health records), organisation of healthcare (primary care, immunisation), and local factors influencing or reflecting resource use (availability of point-of-care tests, admission rates).ResultsReported admission rates ranged from 4% to 51%. In six settings (Athens, Graz, Ljubljana, Riga, Rotterdam, Santiago de Compostela), the supervising ED physicians were general paediatricians, in two (Liverpool, London) these were paediatric emergency physicians, in two (Nijmegen, Newcastle) supervision could take place by either a general paediatrician or a general emergency physician, and in one (München) this could be either a general paediatrician or a paediatric emergency physician. The supervising physician was present on site in all settings during office hours and in five out of eleven settings during out-of-office hours. Guidelines for fever and sepsis were available in all settings; however, the type of guideline that was used differed. Primary care was available in all settings during office hours and in eight during out-of-office hours. There were differences in routine immunisations as well as in additional immunisations that were offered; immunisation rates varied between and within countries.ConclusionDifferences in local, regional and national aspects of care exist in the management of febrile children across Europe. This variability has to be considered when trying to interpret differences in the use of diagnostic tools, antibiotics and admission rates. Any future implementation of interventions or diagnostic tests will need to be aware of this European diversity.

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Section: Discussionmentioning

confidence: 99%

Diversity in the emergency care for febrile children in Europe: a questionnaire study

Borensztajn

Yeung

Hagedoorn

et al. 2019

bmjpo

View full text Add to dashboard Cite

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“…This extended evaluation can determine which illnesses/injuries are more serious and may require hospital admission [26]. The impact of the implementation of an observation unit on hospital admissions is studied and described in two primary studies and two systematic literature reviews [6,11,12,25].…”

Section: Resultsmentioning

confidence: 99%

“…In the more recent study by Karacabeyli et al . [12], a four-bed observation unit was integrated next to a PED (24/7 open and staffed by a nurse and nurse practitioner). The short-stay hospitalisation rate (<48 h) fell from 3.62% before the implementation of an observation unit to 3.23% after the implementation ( P < 0.001).…”

Section: Resultsmentioning

confidence: 99%

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Organisational models at the emergency department to reduce hospital admissions among paediatric patients: a systematic literature review

Detollenaere

Voorde

Heede

2022

European Journal of Emergency Medicine

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Paediatric attendances at the emergency department (ED) are often admitted to the hospital less than 24 h to allow time for more extended evaluation. Innovative organisational models could prevent these hospital admissions without compromising safety or quality of delivered care. Therefore, this systematic review identifies evidence on organisational models at the ED with the primary aim to reduce hospital admissions among paediatric patients. Following the PRISMA guidelines, three bibliographic databases (Ovid Medline, Embase, and Cochrane Library) were searched. Studies on organisational models in Western countries, published between January 2009 and January 2021, which applied a comparative design or review and studied at least hospital admission rates, were included. Analyses were mainly descriptive because of the high heterogeneity among included publications. The primary outcome is hospital admission rates. Secondary outcomes are ED length of stay (LOS), waiting time, and patient satisfaction. Sixteen publications described several innovative organisational models ranging from the creation of dedicated units for paediatric patients, innovative staffing models to bringing paediatric critical care physicians to patients at rural EDs. However, the effect on hospital admission rates and other outcomes are inconclusive, and some organisational models may improve certain outcomes in certain settings or vice versa. It appears that a paediatric consultation liaison team has the most consistent effect on hospital admission rates and LOS of paediatric patients presenting with mental problems at the ED. Implementing new innovative organisational models at the ED for paediatric patients could be worthwhile to decrease hospital admissions. However, the existing evidence is of rather weak quality. Future service developments should, therefore, be conducted in a way that allows objective evaluation.

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System outcomes associated with a pediatric emergency department clinical decision unit

Cited by 2 publications

References 10 publications

Diversity in the emergency care for febrile children in Europe: a questionnaire study

Diversity in the emergency care for febrile children in Europe: a questionnaire study

Organisational models at the emergency department to reduce hospital admissions among paediatric patients: a systematic literature review

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