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Tytuł:
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Crowding is the strongest predictor of left without being seen risk in a pediatric emergency department.
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Autorzy:
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Gorski JK; Department of Pediatrics, Indiana University School of Medicine. 705 Riley Hospital Drive, Indianapolis, IN 46202, USA. Electronic address: .
Arnold TS; Department of Pediatrics, Indiana University School of Medicine. 705 Riley Hospital Drive, Indianapolis, IN 46202, USA; Department of Emergency Medicine, Indiana University School of Medicine. 720 Eskenazi Avenue, Fifth Third Bank Building 3rd Floor, Indianapolis, IN 46202, USA.
Usiak H; Department of Emergency Medicine, Indiana University School of Medicine. 720 Eskenazi Avenue, Fifth Third Bank Building 3rd Floor, Indianapolis, IN 46202, USA.
Showalter CD; Department of Pediatrics, Indiana University School of Medicine. 705 Riley Hospital Drive, Indianapolis, IN 46202, USA; Department of Emergency Medicine, Indiana University School of Medicine. 720 Eskenazi Avenue, Fifth Third Bank Building 3rd Floor, Indianapolis, IN 46202, USA.
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Źródło:
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The American journal of emergency medicine [Am J Emerg Med] 2021 Oct; Vol. 48, pp. 73-78. Date of Electronic Publication: 2021 Apr 03.
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Typ publikacji:
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Journal Article; Observational Study
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Język:
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English
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Imprint Name(s):
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Publication: 1983- : Philadelphia, PA : W B Saunders
Original Publication: [Philadelphia, PA. : Centrum Philadelphia, c1983]-
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MeSH Terms:
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Crowding*
Emergency Service, Hospital*
Patient Acceptance of Health Care/*psychology
Adolescent ; Child ; Child, Preschool ; Female ; Hospitals, Pediatric ; Humans ; Infant ; Infant, Newborn ; Male ; Odds Ratio ; Patient Acceptance of Health Care/statistics & numerical data ; ROC Curve ; Retrospective Studies
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Contributed Indexing:
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Keywords: Left without being seen; Operations research; Overcrowding; Pediatric emergency medicine
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Entry Date(s):
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Date Created: 20210412 Date Completed: 20211021 Latest Revision: 20211021
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Update Code:
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20240105
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DOI:
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10.1016/j.ajem.2021.04.005
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PMID:
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33845424
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Background: Emergency Department (ED) patients who leave without being seen (LWBS) are associated with adverse safety and medico-legal consequences. While LWBS risk has been previously tied to demographic and acuity related factors, there is limited research examining crowding-related risk in the pediatric setting. The primary objective of this study was to determine the association between LWBS risk and crowding, using the National Emergency Department Overcrowding Score (NEDOCS) and occupancy rate as crowding metrics.
Methods: We performed a retrospective observational study on electronic health record (EHR) data from the ED of a quaternary care children's hospital and trauma center during the 14-month study period. NEDOCS and occupancy rate were calculated for 15-min windows and matched to patient arrival time. We leveraged multiple logistic regression analyses to demonstrate the relationship between patientlevel LWBS risk and each crowding metric, controlling for characteristics drawn from the pre-arrival state. We performed a chi-squared test to determine whether a difference existed between the receiver operating characteristic (ROC) curves in the two models. Finally, we executed a dominance analysis using McFadden's pseudo-R 2 to determine the relative importance of each crowding metric in the models.
Results: A total of 54,890 patient encounters were studied, 1.22% of whom LWBS. The odds ratio for LWBS risk was 1.30 (95% CI 1.27-1.33) per 10-point increase in NEDOCS and 1.23 (95% CI 1.21-1.25). per 10% increase in occupancy rate. Area under the curve (AUC) was 86.9% for the NEDOCS model and 86.7% for the occupancy rate model. There was no statistically significant difference between the AUCs of the two models (p-value 0.27). Dominance analysis revealed that in each model, the most important variable studied was its respective crowding metric; NEDOCS accounted for 55.6% and occupancy rate accounted for 53.9% of predicted variance in LWBS.
Conclusion: Not only was ED overcrowding positively and significantly associated with individual LWBS risk, but it was the single most important factor that determined a patient's likelihood of LWBS in the pediatric ED. Because occupancy rate and NEDOCS are available in real time, each could serve as a monitor for individual LWBS risk in the pediatric ED.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
