The impact of an emergency care access point on pediatric patient flows in the emergency department: an observational study
BACKGROUND
Overcrowding is a growing concern in general and pediatric Emergency Departments (EDs). The Emergency Care Access Point (ECAP) – a collaboration between general practitioners and the ED - has been established to reduce the number of self-referrals and non-urgent ED visits. The aim of this study is to determine the impact of an ECAP on pediatric patient flows in the ED.
METHODS
We retrospectively analyzed data of 3,997 pediatric patients who visited the ED of a regional teaching hospital in the Netherlands one year before and after the implementation of an ECAP (April 2014-2015 and April 2015-2016). We compared patient characteristics, presented complaints and diagnoses, throughput times and follow-up between the study groups, and between office hours and after-hours. Mann-Whitney U and chi-square tests were used for continuous and categorical variables, respectively.
RESULTS
After ECAP implementation, a sharp reduction by 16.3% of ED visits under the age of 18 years was observed. ECAP implementation led to a decline of self-referrals by 97.2%. Whilst median waiting time decreased (-1 min), median treatment time increased (+6 min); resulting in a similar median length of stay. Presenting complaints and ED diagnoses were similar. Consultations and follow-up were required more frequently. The admission rate during nights increased (49.3% versus 64.0%). Overall admission rates were similar.
DISCUSSION AND CONCLUSION
The implementation of an ECAP resulted in a reduction of pediatric ED consumption, including a massive decline of pediatric self-referrals and a successful redirection of non-urgent patients to the GPC. Our results also suggest that the mean acuity of pediatric ED visits increased. In conclusion, an ECAP might be an effective tool to reduce the workload in the pediatric ED and it possibly helps tackling the problem of crowding in the ED.
