Utilization of the pediatric emergency department: the experience of a Portuguese center
DOI:
https://doi.org/10.15448/1980-6108.2017.1.24919Keywords:
emergency medicine, emergency health services, pediatrics, overutilization of health services.Abstract
DOI: 10.15448/1980-6108.2017.1.24919
Aims: The excess demand for pediatric emergency services has caused much concern among health professionals and hospital administrators. The aim of this study was to assess the utilization of a pediatric emergency department and to determine whether its use was injudicious.
Methods: Retrospective cross-sectional analysis of all emergency cases treated throughout 2012 in a general hospital located in the metropolitan area of Lisbon, Portugal. The data were obtained from the hospital’s computer information system. Each patient was submitted at admission to the Manchester triage system adapted for Portugal, and the episodes were categorized into immediate, very urgent, urgent, standard, non-urgent, and not classified. All those episodes classified as standard and non-urgent were denoted as unjustified urgent episodes. The data were collected anonymously and analyzed by the IBM SPSS Statistics software using the chi-square test and one-way ANOVA at a 5% significance level (p<0.05).
Results: We analyzed 37,099 pediatric emergency department episodes, of which 19,478 patients were male (53%), the median age was 4 years (interquartile range of 1-9 years), and 78.4% were up to 10 years old. Of all the episodes, 21,177 (57.1%) were classified as standard and 15,470 (41.6%) as urgent or very urgent. Of these patients, 27,294 (73.6%) used the emergency department during the week and 28,679 (77.3%) between 10 a.m. and 12 a.m. It was found that in 90.8% of very urgent, 97.1% of urgent, and 99.4% of standard episodes, patients were discharged without the need for hospitalization.
Conclusions: More than half of the children who used the pediatric emergency department had standard or non-urgent needs, and almost all of them were discharged with follow-up recommendations by the attending physician. Most of the episodes occurred during opening hours of primary healthcare centers.Downloads
References
Goodell S, DeLia D, Cantor JC. Emergency department utilization and capacity. Synth Proj Res Synth Rep. 2009;17:1-5.
Ministério da Saúde (BR). Despacho nº 9871/2010. DR Série II. 2010;112: 32123.
Januário L. A urgência pediátrica na encruzilhada. Rev Saúde Infant. 2010;32(2):51.
Ministério da Saúde (BR). Proposta de requalificação das urgências: esclarecimentos adicionais. Brasília: Ministério da Saúde; 2007. Comunicado nº 1.
Phelps K, Taylor C, Kimmel S, Nagel R, Klein W, Puczynski S. Factors Associated With Emergency Department Utilization for Nonurgent Pediatric problems. Arch Fam Med. 2000;9(10):1086-92. https://doi.org/10.1001/archfami.9.10.1086
Brousseau DC, Bergholte J, Gorelick MH. The effect of prior Interactions with a primary care provider on nonurgent pediatric emergency department use. Arch Pediatr Adolesc Med. 2004;158(1):78-82. https://doi.org/10.1001/archpedi.158.1.78
Ko M, Lee Y, Chen C, Chou P, Chu D. Prevalence of and Predictors for Frequent Utilization of Emergency Department - A Population-Based Study. Med J. 2015;94 (29):1-9. http://dx.doi.org/10.1097/MD.0000000000001205
Contrato-Programa 2012. Metodologia para a definição de preços e fixaçãoo de objectivos. Administração Central do Sistema de Saúde, IP. Lisboa; 2012.
Observatório Português dos Sistemas de Saúde. Relatório de primavera: duas faces da saúde. [Lisboa]: OPSS; 2013.
Contrato-Programa 2014. Metodologia para definição de preços e fixação de objectivos. Administração Central do Sistema de Saúde, IP. Lisboa; 2013.
Portal da codificação GDH [Internet]. Lisboa: Administração Central do Sistema de Saúde; 1989 [uptodate 2002 Apr 2; cited 2016 Oct 14]. Rogério Santos. Hospitais distritais. Available from: http://portalcodgdh.min-saude.pt/index.php/Página_principal
Regulamento interno do Centro Hospitalar Barreiro Montijo.[Lisboa]; 2013.
Pinheiro AP. Referenciação à Urgência Pediátrica do Hospital S. Teotónio – Viseu. Rev Port Clín Ger. 2008;24(67):1-8.
Santos AP, Freitas P, Martins HMG. Manchester triage system version II and resource utilization in emergency department. Emerg Med J. 2010;10:1-5.
Ministério da Saúde (BR). Despacho nº 5414/2008. DR Série II. 2008;42:8083-5.
Mccoy HV, Kipp CW, Ahern M. Reducing older patients' reliance on the emergency department. Soc Work Health Care. 1992;17(1):23-7. https://doi.org/10.1300/J010v17n01_02
Saúde procuram-se novos caminhos. In: Observatório Português dos Sistemas de Saúde. Relatório de primavera. [Lisboa]: OPSS; 2016 p. 21-56.
Northington WE, Brice JH, Zou B. Use of an emergency department by nonurgent patients. Am J Emerg Med. 2005;23(2): 131-7. https://doi.org/10.1016/j.ajem.2004.05.006
Weiss AJ, Wier LM, Stocks C, Blanchard J. Overview of Emergency Department Visits in the United States, 2011. Healthcare cost and utilization project. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs Rockville (MD): Agency for Healthcare Research and Quality (US); 2006.
Caldeira T, Santos G, Pontes E, Dourado R, Rodrigues L. O dia-a-dia de uma Urgência Pediátrica. Acta Pediatr Port. 2006;1(37):1-4.
Grassino EC, Guidi C, Monzani A, Di Pietro P, Bona G. Access to pediatric emergency departments in Italy: a comparisson between immigrant and italian patients. Ital J Pediatr. 2008;35(3):1-5.
Melo EO. Acessibilidade/utilização do serviço de urgência do hospital pediátrico de Coimbra. Rev Enferm (Lisboa). 1999;3:59-62.
Ministério da Saúde (BR). Portaria nº. 147/2016. DR Série I. 2016;97:1616-9.
Pileggi C, Raffaele G, Angelillo IF. Pediatric utilization of an emergency department in Italy. Eur J Public Health. 2006;16(3):563-9.
Dieguez JKI, Candela RC, Velázquez SH, Prieto AG, Fernández LG, De Llano JMA. Estudio de la demanda de asistencia pediátrica en el servicio de urgencias de un hospital general de segundo nivel. Bol Pediatr. 2004;44(187):20-5.
Fisher L, Begley C, Giardino A. The impact of extend hours Primary Care on Emergency Department Use Among Medicaid/SCHIP Enrollees in Houston. School of Public Health, University of Texas. Houston; 2006.
Direção-Geral da Saúde (PO). Divisão de Saúde Materna, Infantil e dos Adolescentes. Saúde Materno-Infantil. Rede de Referenciação Materno-Infantil. Lisboa: Direção-Geral da Saúde; 2001.
Santos MI, Rosário F, Figueiredo C. Padrões temporais de recurso à Urgência Pediátrica: pistas importantes para um modelo de predição da afluência. Acta Ped Port. 2010;41(4):166-70.
Scoble M. Implementing triage in children's assessment unit. Nurs Stand. 2004;18(34):41-4.
Antón MD, Pe-a JC, Santos R, Sempere E, Martínez J, Pérula LA. Demanda inadecuada en un servicio de urgencias pediátrico hospitalario: factores implicados. Med Clin (Barc). 1992;99:743-6.
Fernández P, Lasoasa JC, Hernando FJM, Santervas JF. Estudio de la demanda urgente de asistencia pediátrica en el servicio de urgencias de un hospital infantil. An Esp Pediatr. 1995;42(1):27-30.
Farion KJ, Wright M, Zemek R, Neto G, Karwowska A, Tse S, Reid S, Jabbour M, Poirier S, Moreau KA, Barrowman N. Understanding Low-Acuity Visits to the Pediatric Emergency Department. PLoS One. 2015 Jun 17;10(6):e0128927. https://doi.org/10.1371/journal.pone.0128927
Downloads
Published
How to Cite
Issue
Section
License
Copyright
The submission of originals to Scientia Medica implies the transfer by the authors of the right for publication. Authors retain copyright and grant the journal right of first publication. If the authors wish to include the same data into another publication, they must cite Scientia Medica as the site of original publication.
Creative Commons License
Except where otherwise specified, material published in this journal is licensed under a Creative Commons Attribution 4.0 International license, which allows unrestricted use, distribution and reproduction in any medium, provided the original publication is correctly cited.
