Emergency department overcrowding: Determinants, measures and pediatric outcomes
Children needing emergency care are brought for help to either a general emergency department (ED) that treats patients of all ages or a pediatric unit (PED) dedicated to children. In both settings, timely access to quality care is often threatened by overcrowding. There is substantial evidence about the factors causing overcrowding in general EDs and about the association of overcrowding and poor patient outcomes in adults. In contrast, we know little about the relationships among root causes, measures of overcrowding in PEDs, and pediatric patient outcomes. Although most children are treated in a general ED, research studies conducted in general EDs routinely exclude data from pediatric patients or do not report pediatric-specific outcomes.
Effective management of the acute health care needs of Canadian children requires that we ensure there is adequate ED capacity. To do so, we need to quantify the magnitude and scope of overcrowding in PEDs, and investigate the fate of children seeking care in overcrowded mixed-age general EDs.
Thus, the objectives of Dr. Doan’s research program are to: 1. Document trends in PED utilization (volume and acuity), absolute and per capita, and measure the association between utilization and markers of overcrowding. 2. Measure the association between markers of PED overcrowding on measures of patient outcomes. 3. Compare measures of utilization (volume and acuity), and flow or crowding, using commonly accepted measures of PED overcrowding: waiting time, length of stay (LOS), and proportion of patients leaving without being seen (LWBS) between adults and children in general EDs, as well as between children in general EDs and children seen at PEDs. 4. Measure the association between markers of general ED overcrowding and ED visit outcomes for children using return visits to the ED as a measure of poor outcome and describe these visits’ characteristics (LOS, and dispositions).
Dr. Doan will conduct a series of retrospective cohort studies using administrative databases. The results from these studies will elucidate the root causes, measures of overcrowding in PEDs, and pediatric patient outcomes to better support pediatric patients in EDs.