The increased influx of children with viral and respiratory illnesses to emergency departments (EDs) between September 1 and December 31, 2022, resulted in differing pediatric emergency care standards across various EDs in Michigan, a study examining over 2.7 million ED visits in the state has revealed.
This retrospective study, published on December 7 in JAMA Network Open, included 25 EDs participating in the Michigan Emergency Department Improvement Collaborative (MEDIC). The study analyzed wait times, length of stay (LOS), and ED revisit rates among children (age <18 years) presenting with acute viral and respiratory illnesses to various ED settings: children’s hospitals, urban pediatric high-volume EDs (≥10% of overall visits), urban pediatric low-volume EDs (<10% of overall visits), and rural EDs.
The surge in pediatric visits marked a 71.8% spike compared with the preceding 4 months and a 15.7% increase compared with the same timeframe in 2021.
During this surge, children’s hospitals faced significant challenges. About 8.0% of visits experienced prolonged wait times that exceeded 4 hours, 8.6% faced extended LOS that surpassed 12 hours, and 42 revisits were recorded per 1000 ED visits.
"Fundamentally, long waits are because of a shortage of literal treatment spaces (like rooms in the emergency department) and available treating staff (especially nurses). When the inpatient beds are full, that causes ED boarding, making it difficult for clinicians in the ED to treat new patients as they come in," lead author Dr Alexander Janke, MD, MHS, an instructor in emergency medicine at Yale University School of Medicine and a fellow in the National Clinicians Scholars Program at the University of Michigan, told Medscape Medical News.
Although prolonged wait times were infrequent at other ED sites, the surge’s impact resonated across various EDs, with 2.2% of visits in urban pediatric high-volume EDs, 2.6% in urban pediatric low-volume EDs, and 3.1% in rural EDs enduring prolonged LOS.
The surge highlighted a substantial burden of operational strain faced by children's hospitals compared with other EDs.
Collaborative relationships across children’s hospitals, community EDs, rural sites, and outpatient pediatric practices are critically needed to ensure effective clinical management pathways and quality measures during periods of heightened demand.
"Critically ill children are truly a 'needle in the haystack' problem. It’s all about identifying the rare dangerously ill child and then bringing the necessary resources to them," said Dr Janke. "When small, outlying EDs collaborate with the larger centers that helps keep (a) the kids that will do fine out of the hospital and (b) the kids who need specialized critical care safe no matter what hospital they start out at," he added.
Moreover, the findings shed light on the urgency of addressing disparities in access and quality of care, urging policymakers and healthcare leaders to consider the financial and operational aspects of pediatric acute care. The research emphasized rewarding readiness and preparedness for surges in care demand, calling for concerted efforts to ensure timely and high-quality care delivery to all children across diverse healthcare settings.
"One big picture challenge we face is that inpatient pediatric beds can be financially difficult for hospitals to maintain. That means when the 'surge' does hit, there are not enough beds ready to meet demands. We need a financial model of pediatric care that maintains broad pediatric readiness and surge preparedness, so that all kids get the best possible care when they’re sick," noted Dr Janke.
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