Evaluating the transitions in care for children presenting with acute asthma to emergency departments: a retrospective cohort study

BMC Emergency Medicine

Brian H. Rowe¹  Kimberly R. Kroetch²  Rhonda J. Rosychuk³ 

[1] Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, T6G 2R7, Edmonton, Alberta, Canada;School of Public Health, University of Alberta, Edmonton, Alberta, Canada;Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada;Department of Mathematics and Statistics, Faculty of Arts and Science, MacEwan University, T5J 4S2, Edmonton, Alberta, Canada;Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Rm 3-524, Edmonton Clinic Health Academy, 11405 87 Avenue NW, T6G 1C9, Edmonton, Alberta, Canada;Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada;Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada;

关键词: Multistate models;    Emergency department;    Pediatrics;    Asthma;    Administrative data;   

DOI  :  10.1186/s12873-021-00550-z

来源: Springer

【 摘 要 】

BackgroundAcute asthma is a common presentation to emergency departments (EDs) worldwide and, due to overcrowding, delays in treatment often occur. This study deconstructs the total ED length of stay into stages and estimates covariate effects on transition times for children presenting with asthma.MethodsWe extracted ED presentations in 2019 made by children in Alberta, Canada for acute asthma. We used multivariable Cox regressions in a multistate model to model transition times among the stages of start, physician initial assessment (PIA), disposition decision, and ED departure.ResultsData from 6598 patients on 8270 ED presentations were extracted. The individual PIA time was longer (i.e., HR < 1) when time to the crowding metric (hourly PIA) was above 1 h (HR = 0.32; 95% CI:0.30,0.34), for tertiary (HR = 0.65; 95% CI:0.61,0.70) and urban EDs (HR = 0.77; 95% CI:0.70,0.84), for younger patients (HR = 0.99 per year; 95% CI:0.99,1.00), and for patients triaged less urgent/non-urgent (HR = 0.89; 95% CI:0.84,0.95). It was shorter for patients arriving by ambulance (HR = 1.22; 95% CI:1.04,1.42). Times from PIA to disposition decision were longer for tertiary (HR = 0.47; 95% CI:0.44,0.51) and urban (HR = 0.69; 95% CI:0.63,0.75) EDs, for patients triaged as resuscitation/emergent (HR = 0.51; 95% CI:0.48,0.54), and for patients arriving by ambulance (HR = 0.78; 95% CI:0.70,0.87). Times from disposition decision to ED departure were longer for patients who were admitted (HR = 0.16; 95% CI:0.13,0.20) or transferred (HR = 0.42; 95% CI:0.35,0.50), and for tertiary EDs (HR = 0.93; 95% CI:0.92,0.94).ConclusionsAll transition times were impacted by ED presentation characteristics. The sole key patient characteristic was age and it only impacted time to PIA. ED crowding demonstrated strong effects of time to PIA but not for the transition times involving disposition decision and ED departure stages.

【 授权许可】

CC BY