As Volume Goes Up, Quality of Care Goes Down in Pediatric Emergency Rooms

Most children who show up in the pediatric emergency department (PED) have a “regular” pediatrician or primary care physician—but not necessarily access to those physicians at times their parents think it’s absolutely necessary for their child to see a doctor, say the authors of a new article published in Pediatric Emergency Care. This leads to a two-fold problem: First, overcrowding in PEDs and, ultimately, diminished quality of care, according to their data. Second, as is the case with patients of all ages, too many of those visits to the PED turn out to be nonemergent. Out of 635 patients with a Paediatric Canadian Triage and Acuity Score of 4 or 5, only 25% were found to need truly emergent care at the time of their PED visit. Perceived expertise at the tertiary care hospital and ease of getting test results were the most common reasons (93% and 81%, respectively) for the children to have been brought in. The authors concluded that greater access to physicians outside of “normal” office hours, including testing capabilities, would likely reduce unnecessary trips to PEDs and, as a result, improve the quality of care for all. Though urgent care was not part of the discussion, it seems likely the  growth of the pediatric urgent care center market in the U.S.—which by its very nature will increase access as described by the authors—will help ease the traffic in PEDs and improve quality of care across the board.