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Aim Examine costs associated with acute mental health presentations (AMHP) to a paediatric emergency department (ED) in 2016 and 2018. Methods Case identification and bed costs were calculated. Results In 2018, 163 youths attended the ED with AMHP, 122 (75%) were admitted (average 8 days), representing a yearly cost to the hospital of 1,028,020, average cost per patient 8,426. This marks an increase of 425,320 or 2,686 per patient compared to 2016. Arriving out of hours, presence of self-harm (SH) and discharge to an inpatient psychiatry bed were all associated with greater costs. Conclusion Despite increasing hospital costs associated with out of hours psychiatric emergencies, dedicated funding is not yet in place. All children should have access to urgent MH assessment. Work force planning and creation of pathways of care for young people with MH needs, including dedicated funding from HSE mental health division must be a priority.
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Atención Posterior/economía , Costos y Análisis de Costo , Servicio de Urgencia en Hospital/economía , Hospitalización/economía , Tiempo de Internación/economía , Trastornos Mentales/economía , Trastornos Mentales/epidemiología , Servicios de Salud Mental/economía , Salud Mental/economía , Medicina de Urgencia Pediátrica/economía , Enfermedad Aguda , Adolescente , Niño , Femenino , Humanos , Masculino , Conducta Autodestructiva/economía , Factores de TiempoRESUMEN
BACKGROUND: Although concussion-related emergency department (ED) visits increased after the passage of concussion laws, little is known about how the laws may disproportionately impact ED utilization and associated health care costs among children in different demographic groups. OBJECTIVE: Our aim was to examine the patient and clinical characteristics of pediatric ED visits and associated health care costs for sports- and recreation-related concussions (SRRCs) before and after concussion law enactment. METHODS: We retrospectively analyzed ED visits for SRRCs by children ages 5-18 years between 2006 and 2014 in the Pediatric Health Information System database (n = 123,220). ED visits were categorized as "pre-law," "immediate post-law," and "post-law" according to the respective state concussion law's effective date. Multinomial logistic regression models were used to assess the impact of the law on ED utilization. RESULTS: The majority of visits were by males (n = 83,208; 67.6%), children aged 10-14 years (n = 49,863; 40.9%), and privately insured patients (n = 62,376; 50.6%). Female sex, older age, and insured by Medicaid/Medicare were characteristics associated with increased ED visits during the immediate post-law and post-law periods compared to their counterparts. A significant decrease in proportion of imaging use was observed from pre-law to post-law (adjusted odds ratio 0.49; 95% confidence interval 0.47-0.50; p < 0.0001). While annual adjusted costs per ED visits decreased, annual total adjusted costs per hospital for SRRCs increased from pre-law to post-law (p < 0.0001). CONCLUSIONS: Concussion laws might have impacted pediatric concussion-related ED utilization, with increased annual total adjusted costs. These results may have important implications for policy interventions and their effects on health care systems.
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Traumatismos en Atletas/economía , Conmoción Encefálica/economía , Medicina de Urgencia Pediátrica/economía , Adolescente , Traumatismos en Atletas/epidemiología , Conmoción Encefálica/epidemiología , Niño , Preescolar , Costos y Análisis de Costo , Servicio de Urgencia en Hospital/organización & administración , Femenino , Costos de la Atención en Salud , Humanos , Modelos Logísticos , Masculino , Oportunidad Relativa , Medicina de Urgencia Pediátrica/métodos , Estudios RetrospectivosRESUMEN
OBJECTIVE: The aim of this study was to delineate pediatric emergency medicine provider opinions regarding the importance of, and to ascertain existing processes by which practitioners maintain, the following critical procedural skills: oral endotracheal intubation, intraosseous line placement, pharmacologic and electrical cardioversion, tube thoracostomy, and defibrillation. METHODS: A customized survey was administered to all members of the Listserv for the American Academy of Pediatrics Section on Emergency Medicine. Perceived importance of maintaining critical pediatric procedural skills was measured using a 5-point Likert-type scale. Secondary outcomes included presence and type of mandatory training, availability of on-site backup, and perceived barriers to maintenance of skills. RESULTS: Two hundred sixty-two members (25%) responded representing 106 different institutions, 70% of freestanding children's hospitals that received graduate medical education payments in 2014, and 68% of pediatric emergency medicine fellowship programs. More than 90% of respondents felt it was either very or extremely important to maintain competency for 5 of the 6 critical procedures, but no more than 49% of respondents felt that clinical care alone provided opportunity to maintain skills. The proportion of respondents indicating no mandatory training for each critical procedural skill was as follows: oral endotracheal intubation (23%), intraosseous line placement (30%), pharmacologic cardioversion (32%), electrical cardioversion (32%), tube thoracostomy (40%), and defibrillation (32%). CONCLUSIONS: Critical procedural skills are perceived by emergency providers who care for children as extremely important to maintain. Direct care of pediatric patients likely does not provide sufficient opportunity to maintain these skills. There are widespread deficiencies relating to mandatory maintenance of critical procedural skill training.
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Competencia Clínica/estadística & datos numéricos , Cuidados Críticos/métodos , Medicina de Emergencia/educación , Hospitales Pediátricos/estadística & datos numéricos , Actitud del Personal de Salud , Niño , Cuidados Críticos/tendencias , Estudios Transversales , Educación de Postgrado en Medicina/economía , Cardioversión Eléctrica/estadística & datos numéricos , Humanos , Intubación Intratraqueal/estadística & datos numéricos , Medicina de Urgencia Pediátrica/economía , Medicina de Urgencia Pediátrica/educación , Percepción/fisiología , Encuestas y Cuestionarios , Toracostomía/estadística & datos numéricos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To evaluate the clinical and microbiological factors associated with skin and soft tissue infections drained in the emergency department (ED) vs operative drainage (OD) in a tertiary care children's hospital. METHODS: This was a cross-sectional study among children aged 2 months to 17 years who required incision and drainage (I&D). Demographic information, signs and symptoms, abscess size and location, and wound culture/susceptibility were recorded. Patient-specific charges were collected from the billing database. Multivariate regression analysis was used to determine factors determining setting for I&D and the effect of abscess drainage location on cost. RESULTS: Of 335 abscesses, 241 (71.9%) were drained in the ED. OD for abscesses was favored in children with prior history of abscess (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.36-7.44; P = .01) and labial location (OR, 37.81; 95% CI, 8.12-176.03; P < .001). For every 1-cm increase in size, there was approximately a 26% increase in the odds of having OD (OR, 1.26; 95% CI, 1.11-1.44, P < .001). Methicillin-resistant Staphylococcus aureus was identified in 72% of the 300 abscesses cultured and 12.3% were clindamycin resistant. OD was more expensive than I&D in the ED. Per abscess that underwent I&D, OD is $3804.29 more expensive than I&D in the ED while controlling for length of stay. DISCUSSION: Clinical factors associated with OD rather than I&D in the ED included history of abscess, increased abscess length, and labial location. Microbiological factors did not differ based on I&D setting. For smaller, nonlabial abscesses, ED drainage may result in significant cost savings.
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Absceso/cirugía , Procedimientos Quirúrgicos Dermatologicos/métodos , Enfermedades Cutáneas Infecciosas/cirugía , Infecciones de los Tejidos Blandos/cirugía , Infecciones Estafilocócicas/cirugía , Absceso/economía , Adolescente , Niño , Preescolar , Costos y Análisis de Costo , Estudios Transversales , Procedimientos Quirúrgicos Dermatologicos/economía , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Femenino , Hospitales Pediátricos/economía , Hospitales Pediátricos/estadística & datos numéricos , Hospitales Urbanos/economía , Hospitales Urbanos/estadística & datos numéricos , Humanos , Lactante , Masculino , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Análisis Multivariante , Medicina de Urgencia Pediátrica/economía , Medicina de Urgencia Pediátrica/métodos , Medicina de Urgencia Pediátrica/estadística & datos numéricos , Estudios Retrospectivos , Enfermedades Cutáneas Infecciosas/economía , Infecciones de los Tejidos Blandos/economía , Infecciones Estafilocócicas/economía , Estadísticas no Paramétricas , Succión/economía , Succión/métodosRESUMEN
OBJECTIVE: The aim of this study was to determine variables predictive of abnormal comprehensive metabolic panel (CMP) results in pediatric emergency department (PED) patients and the potential cost savings of a basic metabolic panel (BMP) versus a CMP. METHODS: This is a retrospective cross-sectional descriptive study of children (<18 y) at an urban academic PED (annual census, 22,000). Clinical data included 12 clinical variables: right upper quadrant pain, overdose, emesis, liver disorder, malignancy, heart disease, bleeding disorder, jaundice, right upper quadrant tenderness, hepatomegaly, ascites/peripheral edema and shock, and the liver function test (LFT) results not in a BMP (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin, total protein, and albumin). RESULTS: There were 207 children in the study population. The mean age was 8 years. There were 106 boys (51%).Variables significantly associated with abnormal LFT result were history of liver disease (P = 0.007), history of heart disease (P = 0.040), jaundice (P = 0.045), and hepatomegaly (P = 0.048). The false-negative rate was 16%. However, of the 10 patients for whom this false-negative rate remained true, the LFT values were marginally abnormal, and performance of further investigation of these results was minimal to none. There were 66 patients with no clinical variables and normal CMP results. With a cost difference of $21 between BMP and CMP, this gives a potential savings of $7125 if extrapolated for 1 year in our PED. CONCLUSIONS: Limiting testing to a BMP for patients with none of the 12 clinical variables has the potential annual cost savings of $7125.
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Ahorro de Costo/economía , Pruebas Diagnósticas de Rutina/economía , Servicio de Urgencia en Hospital/economía , Medicina de Urgencia Pediátrica/economía , Niño , Costos y Análisis de Costo/métodos , Estudios Transversales , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Reacciones Falso Negativas , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Pruebas de Función Hepática/economía , Pruebas de Función Hepática/métodos , Pruebas de Función Hepática/estadística & datos numéricos , Masculino , Valor Predictivo de las Pruebas , Estudios RetrospectivosRESUMEN
Acute care of seriously ill children is a global public health issue, and there is much scope for improving quality of care in hospitals at all levels in many developing countries. We describe the current state of paediatric emergency and acute care in the least developed regions of low and middle income countries and identify gaps and requirements for improving quality. Approaches are needed which span the continuum of care: from triage and emergency treatment, the diagnostic process, identification of co-morbidities, treatment, monitoring and supportive care, discharge planning and follow-up. Improvements require support and training for health workers and quality processes. Effective training is that which is ongoing, combining good technical training in under-graduate courses and continuing professional development. Quality processes combine evidence-based guidelines, essential medicines, appropriate technology, appropriate financing of services, standards and assessment tools and training resources. While initial emergency treatment is based on common clinical syndromes, early differentiation is required for specific treatment, and this can usually be carried out clinically without expensive tests. While global strategies are important, it is what happens locally that makes a difference and is too often neglected. In rural areas in the poorest countries in the world, public doctors and nurses who provide emergency and acute care for children are revered by their communities and demonstrate daily that much can be carried out with little.
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Cuidados Críticos/métodos , Países en Desarrollo , Tratamiento de Urgencia/métodos , Medicina de Urgencia Pediátrica/métodos , Niño , Cuidados Críticos/economía , Cuidados Críticos/normas , Tratamiento de Urgencia/economía , Tratamiento de Urgencia/normas , Humanos , Medicina de Urgencia Pediátrica/economía , Medicina de Urgencia Pediátrica/normas , Mejoramiento de la CalidadRESUMEN
This article discusses the implications of health care reform on the pediatric emergency department (ED). The author briefly discusses the health care costs and outcomes in the United States in comparison to other developed nations. The article discusses the impact of the Affordable Care Act and insurance expansion on the pediatric ED. Then the article addresses the impacts of the growing patient financial responsibility on ED use. There will be a discussion of the development of pediatric accountable care organizations and how payment mechanisms are evolving, and the challenges the pediatric ED may face in these new payment strategies.