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- Title
Identifying Key Metrics for Reducing Premature Departure from the Pediatric Emergency Department Cross et al. KEY METRICS FOR REDUCING PREMATURE DEPARTURE.
- Authors
Cross, Keith P.; Gracely, Edward; Stevenson, Michelle D.; Woods, Charles R.
- Abstract
Approximately 2% to 5% of children presenting to pediatric emergency departments (PEDs) leave prior to a complete evaluation. This study assessed risk factors for premature departure (PD) from a PED to identify key metrics and cutoffs for reducing the PD rate. A 3-year cohort (June 2004-May 2007) of children presenting to a PED was evaluated. Children were excluded if they presented for psychiatric issues, were held awaiting hospital admission in the PED due to a lack of inpatient beds, were more than 21 years old, or died before disposition. Univariate analyses, multivariable logistic regression, and recursive partitioning were used to identify factors associated with PD. A fourth year of data (June 2007-May 2008) was used for validation and sensitivity analysis. There were 132,324 patient visits in the 3-year derivation data set with a 3.8% PD rate, and 45,001 visits in the fourth-year validation data set with a 4.3% PD rate. PDs were minimized when average wait time was below 110 minutes, concurrent PDs were fewer than two, and average length of stay (LOS) was less than 224 minutes in the derivation set, with similar results in the validation set. When these metrics were exceeded, PD rates were over 10% among low-acuity patients. These findings were robust across a broad range of assumptions during sensitivity analysis. The authors identified five key metrics associated with PD in the PED: average wait time, average LOS, acuity, concurrent PDs, and arrival rate. Operational cutoffs for these metrics, determined by recursive partitioning, may be useful to physicians and administrators when selecting specific interventions to address PDs from the PED. ACADEMIC EMERGENCY MEDICINE 2010; 17:1197-1206 © 2010 by the Society for Academic Emergency Medicine
- Subjects
ANALYSIS of variance; CHI-squared test; CLASSIFICATION; COMPUTER software; EMERGENCY medical services; FISHER exact test; HEALTH services accessibility; LENGTH of stay in hospitals; HOSPITAL admission &; discharge; HOSPITAL emergency services; LONGITUDINAL method; MEDICAL care use; HEALTH outcome assessment; PATIENTS; RESEARCH funding; STATISTICS; T-test (Statistics); TIME series analysis; MEDICAL triage; U-statistics; LOGISTIC regression analysis; DATA analysis; MULTIPLE regression analysis; PATIENT refusal of treatment; RETROSPECTIVE studies; SEVERITY of illness index; CHILDREN
- Publication
Academic Emergency Medicine, 2010, Vol 17, Issue 11, p1197
- ISSN
1069-6563
- Publication type
Article
- DOI
10.1111/j.1553-2712.2010.00908.x