RT Journal Article
SR Electronic
T1 The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E627
OP E635
DO 10.1503/cmaj.181426
VO 191
IS 23
A1 Doan, Quynh
A1 Wong, Hubert
A1 Meckler, Garth
A1 Johnson, David
A1 Stang, Antonia
A1 Dixon, Andrew
A1 Sawyer, Scott
A1 Principi, Tania
A1 Kam, April J.
A1 Joubert, Gary
A1 Gravel, Jocelyn
A1 Jabbour, Mona
A1 Guttmann, Astrid
A1 
YR 2019
UL http://www.cmaj.ca/content/191/23/E627.abstract
AB BACKGROUND: Emergency department overcrowding has been associated with increased odds of hospital admission and mortality after discharge from the emergency department in predominantly adult cohorts. The objective of this study was to evaluate the association between crowding and the odds of several adverse outcomes among children seen at a pediatric emergency department.METHODS: We conducted a retrospective cohort study involving all children visiting 8 Canadian pediatric emergency departments across 4 provinces between 2010 and 2014. We analyzed the association between mean departmental length of stay for each index visit and hospital admission within 7 days or death within 14 days of emergency department discharge, as well as hospital admission at index visit and return visits within 7 days, using mixed-effects logistic regression modelling.RESULTS: A total of 1 931 465 index visits occurred across study sites over the 5-year period, with little variation in index visit hospital admission or median length of stay. Hospital admission within 7 days of discharge and 14-day mortality were low across provinces (0.8%–1.5% and < 10 per 100 000 visits, respectively), and their association with mean departmental length of stay varied by triage categories and across sites but was not significant. There were increased odds of hospital admission at the index visit with increasing departmental crowding among visits triaged to Canadian Triage and Acuity Scale (CTAS) score 1–2 (odds ratios [ORs] ranged from 1.01 to 1.08) and return visits among patients with a CTAS score of 4–5 discharged at the index visit at some sites (ORs ranged from 1.00 to 1.06).INTERPRETATION: Emergency department crowding was not significantly associated with hospital admission within 7 days of the emergency department visit or mortality in children. However, it was associated with increased hospital admission at the index visit for the sickest children, and with return visits to the emergency department for those less sick.See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.190610