Correlation of measures of patient acuity with measures of crowding in a pediatric emergency department.

OBJECTIVE: Emergency department (ED) crowding is an increasingly common problem in the United States. Crowding can lead to ED closure and diversion, poor patient satisfaction, and patient safety issues. The purpose of this study was to examine measures of ED census and measures of crowding to determine if a correlation exists in a pediatric ED setting. METHODS: Arkansas Children's Hospital is a major pediatric referral center. Measures of ED acuity (including total census, admission rate, total number of admissions, and proportion of triage category nonurgent patients) and measures of throughput (left-without-being-seen [LWBS] rate and ED length of stay [LOS]) data for 11 years (1996-2006) were plotted, and correlation coefficients were calculated. RESULTS: Annual ED census varied between 35,415 and 40,711 during the 11-year study period. The total number of admissions increased from 4179 in 1996 to 6539 in 2006. When total census was plotted against LWBS rate and ED LOS, a poor correlation was found (R² = 0.007 for total census vs LWBS rate). However, a strong correlation was found when the relationship between the total number of admissions and LWBS rate was examined (R² = 0.89). Similarly, a strong relationship between the admission rate and LWBS rate was seen (R² = 0.75). In addition, a strong correlation was seen between admissions (total and percentage) versus ED LOS. CONCLUSIONS: There is a strong correlation between the number of patients admitted and measures of overcrowding in this pediatric ED, but there is a poor correlation between the total census and overcrowding measures. Targeting process improvement on hospital-wide patient flow may help reduce ED crowding.

Prehospital preparedness for pediatric mass-casualty events.

OBJECTIVES: Recent events have reiterated the need for well-coordinated planning for mass-casualty events, including those that involve children. The objective of this study was to document the preparedness of prehospital emergency medical services agencies in the United States for the care of children who are involved in mass-casualty events. METHODS: A national list of all licensed prehospital emergency medical services agencies was prepared through contact with each state's emergency medical services office. A survey was mailed to 3748 emergency medical services agencies that were selected randomly from the national list in November 2004; a second survey was mailed to nonresponders in March 2005. Descriptive statistics were used to describe study variables. RESULTS: Most (72.9%) agencies reported having a written plan for response to a mass-casualty event, but only 248 (13.3%) reported having pediatric-specific mass-casualty event plans. Most (69%) services reported that they did not have a specific plan for response to a mass-casualty event at a school. Most (62.1%) agencies reported that their mass-casualty event plan does not include provisions for people with special health care needs. Only 19.2% of the services reported using a pediatric-specific triage protocol for mass-casualty events, and 12.3% reported having a pediatrician involved in their medical control. Although most (69.3%) agencies reported participation in a local or regional disaster drill in the past year, fewer than half of those that participated in drills (49.0%) included pediatric victims. CONCLUSIONS: Although children are among the most vulnerable in the event of disaster, there are substantial deficiencies in the preparedness plans of prehospital emergency medical services agencies in the United States for the care of children in a mass-casualty event.

Mass-casualty events at schools: a national preparedness survey.

OBJECTIVE: Recent school shootings and terrorist events have demonstrated the need for well-coordinated planning for school-based mass-casualty events. The objective of this study was to document the preparedness of public schools in the United States for the prevention of and the response to a mass-casualty event. METHODS: A survey was mailed to 3670 school superintendents of public school districts that were chosen at random from a list of school districts from the National Center for Education Statistics of the US Department of Education in January 2004. A second mailing was sent to nonresponders in May 2004. Descriptive statistics were used for survey variables, and the chi2 test was used to compare urban versus rural preparedness. RESULTS: The response rate was 58.2% (2137 usable surveys returned). Most (86.3%) school superintendents reported having a response plan, but fewer (57.2%) have a plan for prevention. Most (95.6%) have an evacuation plan, but almost one third (30%) had never conducted a drill. Almost one quarter (22.1%) have no disaster plan provisions for children with special health care needs, and one quarter reported having no plans for postdisaster counseling. Almost half (42.8%) had never met with local ambulance officials to discuss emergency planning. Urban school districts were better prepared than rural districts on almost all measures in the survey. CONCLUSIONS: There are important deficiencies in school emergency/disaster planning. Rural districts are less well prepared than urban districts. Disaster/mass-casualty preparedness of schools should be improved through coordination of school officials and local medical and emergency officials.