The impact of critically ill children on paediatric ED medication timeliness.
Emerg Med J
; 34(1): 8-12, 2017 Jan.
Article
em En
| MEDLINE
| ID: mdl-27694335
OBJECTIVES: The presence of critically ill patients may impact care for other ED patients. We sought to evaluate whether the presence of a critically ill child was associated with the time to (1) receipt of the first medication among other patients, and (2) administration of diagnosis-specific medications. METHODS: We performed a retrospective cohort study of all paediatric ED visits over 3â
years. Patients were exposed if they arrived during the first hour of a critically ill patient's care. The primary outcome was the time from arrival to first medication administration. Secondary outcomes were time to corticosteroids in asthma and time to antibiotics for fever/neutropenia. We modelled times to medication using median regression, adjusting for demographics, arrival time and weekday, and census (number of patients in the ED). RESULTS: We analysed 170â
112 visits. Median times to first medication for those exposed to 0, 1 and >1 simultaneous critically ill patients were 90â
min (IQR 54-146), 96â
min (IQR 58-157) and 113 min (IQR 72-166), respectively (p<0.001). The increase in time to corticosteroids among exposed patients versus unexposed was 6â
min (IQR 2-14, p=0.11) and in time to antibiotic for fever/neutropenia was -4â
min (IQR -4 to -11, p=0.13). Modelled time to first medication increased 3.1â
min (95% CI 0.5 to 5.7) among all exposed patients (p=0.02). Time to first medication increased 15.3â
min (95% CI 14.7 to 15.9) for each 10 patient increase in census. CONCLUSIONS: The presence of critically ill patients was associated with a delay in medication administration to others. Census independently predicted medication delays.
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Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Asma
/
Estado Terminal
/
Serviço Hospitalar de Emergência
/
Febre
/
Tempo para o Tratamento
/
Gastroenterite
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Child
/
Female
/
Humans
/
Male
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article