Variation in Emergency Department Admission Rates in US Children’s Hospitals

Abstract

WHAT'S KNOWN ON THIS SUBJECT: There is substantial variation in the medical care provided to pediatric patients across diverse clinical settings. This variation raises concerns about whether every patient is receiving optimal care and whether more standardized approaches around clinical decisions are needed. WHAT THIS STUDY ADDS:We observed wide variation in admission rates for common pediatric conditions across US children' s hospitals. Our findings highlight the need for greater focus on the standardization of decisions regarding hospitalization of patients presenting to the emergency department.abstract OBJECTIVE: To measure the hospital-level variation in admission rates for children receiving treatment of common pediatric illnesses across emergency departments (EDs) in US children' s hospitals. METHODS:We performed a multi-center cross sectional study of children presenting to the EDs of 35 pediatric tertiary-care hospitals participating in the Pediatric Health Information System (PHIS). Admission rates were calculated for visits occurring between January 1, 2009, and December 31, 2012, associated with 1 of 7 common conditions, and corrected to adjust for hospital-level severity of illness. Conditions were selected systematically based on frequency of visits and admission rates.RESULTS: A total of 1 288 706 ED encounters (13.8% of all encounters) were associated with 1 of the 7 conditions of interest. After adjusting for hospital-level severity, the greatest variation in admission rates was observed for concussion (range 5%-72%), followed by pneumonia (19%-69%), and bronchiolitis (19%-65%). The least variation was found among patients presenting with seizures (7%-37%) and kidney and urinary tract infections (6%-37%). Although variability existed in diseasespecific admission rates, certain hospitals had consistently higher, and others consistently lower, admission rates. CONCLUSIONS:We observed greater than threefold variation in severityadjusted admission rates for common pediatric conditions across US children's hospitals. Although local practices and hospital-level factors may partly explain this variation, our findings highlight the need for greater focus on the standardization of decisions regarding admission. Pediatrics 2014;134:539-545 AUTHORS:

Quality Improvement Effort to Reduce Cranial CTs for Children With Minor Blunt Head Trauma

“…To investigate whether any observed changes in CT rate could be explained by a temporal trend, we compared the study institution CT rate by quarter to the other 34 tertiary-care pediatric EDs that contributed reliable ED visit data to the Pediatric Hospital International System (PHIS) administrative database 15 during the study period (January 1, 2010–June 30, 2014). For this analysis, we identified children aged ≤21 years with a head trauma ED discharge code (using the same International Classification of Disease codes as noted earlier) from the PHIS database for both the study institution and the comparison hospitals.…”

Predicting Severe Pneumonia Outcomes in Children

“…1,2 Consequently, pneumonia ranks among the top 3 reasons for pediatric hospitalization. 3,4 However, the proportion of children presenting to the ED with pneumonia who are hospitalized varies widely, 5,6 ranging from 19% to 69% among 35 US children's hospitals. 6 This variation is largely independent of population differences or illness severity, 5-7 suggesting a need for standardized methods to improve identification of children at risk for severe outcomes.…”

Direct concurrent comparison of multiple pediatric acute asthma scoring instruments

“…[27] Low reliability of some of these same instruments has been reported recently in a video-based comparison of instruments by Eggink et al. [43] Our results may be more accurate as they reflect performance of these instruments under actual clinical practice in an academic pediatric emergency department.…”