Emergency Department Crowding Is Associated With Decreased Quality of Care for Children

• DOI: 10.1097/pec.0b013e31822c1382
• Publication Date: 2011-10-04T18:34:51Z
• Authors: Marion R. Sills; Diane Fairclough; Daksha Ranade; Michael G. Kahn
• Keywords: Crowding

Objective: We sought to determine which of several simple indicators emergency department crowding are most predictive quality care in 2 pediatric disease models: acute asthma and pain associated with long-bone fractures. Methods: performed a retrospective, cross-sectional study patients 21 years old seen for 0 acute, isolated fractures from November 1, 2007, October 31, 2008, at single, academic children's hospital department. The main outcome measures were based on 3 care-related processes-asthma score, β-agonist, corticosteroid-and fracture-related processes-analgesic opioid analgesic. Good was defined as receipt an indicated process within 1 hour arrival. Poor nonreceipt or delayed process. Nine assigned conditions each patient's calculated the adjusted risk receiving good measure 5 percentiles measure. Results: population included 927 patients, fracture 1229 patients. Among measures, we found rates ranging 23% 64%. In models, inverse association between quality. consistently across both populations total patient-care hours number arriving prior 6 hours. Across 10 models combining key variables 0.40 (95% confidence interval, 0.27-0.55) 0.78 (confidence 0.71-0.85) times likely receive when 75th than 25th percentile. Conclusions: Two ED lower-quality asthma- fracture-specific