Unclogging the Pediatric Emergency Room: Impact of Rapid Viral Diagnostics
To determine if use of a new program to support rapid diagnosis of viral respiratory infections in children will improve patient management and resource use in the Emergency Department by reducing wait time, improving decision making regarding diagnosis and decreasing antibiotic prescriptions.
Acute respiratory tract infections, which cause symptoms including fever, coughing and difficulty breathing, are among the most common ailments of childhood, particularly among infants and children younger than 3 years old. These infections account for the majority of antibiotic prescriptions to children, in spite of the fact that most of these infections will resolve on their own and do not require medical intervention. However, these symptoms overlap significantly with those of severe viral or bacterial infections which do require treatment, and physicians in emergency departments – in the absence of a definitive viral diagnosis – may order precautionary diagnostic tests and prescribe antibiotics. As a result, children and their families typically spend about three hours in the emergency department before results are available. This waiting time is difficult for children and families and costly in terms of tying up emergency department human resources and facilities. Emergency departments require better, faster diagnostics to manage patients, especially during peak flu season (November to March).
This research project is designed to assess if a modified method of using VIRAP – a screening program for rapid diagnosis of respiratory viral infections developed during the SARS outbreak in 2003 – can reduce backlogs and waiting times in the emergency department at BC Children’s Hospital. Rather than waiting for an emergency physician to order use of VIRAP, the testing protocol would be initiated by a nurse during the initial assessment of the child. This modification in protocol would mean that test results would be available for the physician when he/she first assesses the child, leading to improved decision making and more timely care for the child. This in turn would reduce waiting times and use of hospital resources.
Through this study, the research team will assess whether or not using VIRAP at triage to support rapid diagnosis of viral infection in children at Children’s Hospital will:
- reduce the waiting time in the Emergency Department;
- improve decision-making regarding diagnostic investigations and specimen collection; and
- decrease antibiotic prescriptions.
204 children were enrolled, of which 200 were analysed. 90 underwent VIRAP at triage. We found a lower rate of antibiotic prescription post ED discharge in children undergoing VIRAP at triage; risk of receiving antibiotics was 0.36 time that of those not receiving VIRAP (95% Confidence Interval=0.14, 0.95) and children with a confirmed viral diagnosis by VIRAP had on average 68.5mins (with 95% Confidence Interval = 9-128 min) shorter LOV than the others. We did not demonstrate a significant effect on rate of other testing or antibiotic prescription rate in the ED.
Our study showed that confirmation of viral respiratory infection reduces ED length of visits and suggest a novel strategy to alter community physician antibiotic prescription patterns and affect the problem of antibiotic resistance. A prospectively planned economic evaluation of a VIRAP like program’s impact will be essential in order to recommend its implementation in other centers.