The following is a summary of “Effect of increased emergency department demand on throughout times and disposition status for pediatric psychiatric patients,” published in the February 2023 issue of Emergency Medicine by Brathwaite, et al.

It had been demonstrated that crowded emergency departments (EDs) resulted in longer lengths of stay (LOS), longer wait times, and longer boarding times. In addition, utilization of psychiatric services in the ED has grown, especially among younger patients. For a study, researchers measured the impact of ED demand on pediatric psychiatric patients’ throughput times and discharge options.

They found 14,092 pediatric psychiatric visits using electronic medical record data from 1,151,396 ED visits in eight North Carolina EDs from January 1, 2018, to December 31, 2020. Overall occupancy, as well as the daily proportion of adult, pediatric, and non-psychiatric patients, were used as indicators of the daily demand rates for EDs. They employed logistic regression to predict disposition status and linear regression to predict throughput times while controlling for patient-level variables such as age, sex, race, insurance, and triage acuity. Due to disparities in ED and inpatient resource availability, they calculated the impact of ED demand by academic versus community hospital status.

With regard to throughput metrics for pediatric psychiatric patients, the majority of ED demand indicators exhibited negligible or hardly detectable relationships. With notable exceptions, boarding times at community sites increased by 1.06 hours (95% CI: 0.20-1.92) for every percentage point increase in non-psychiatric pediatric ED visits, while at the academic site, LOS increased by 3.64 hours (95% CI: 2.04-5.23) for every percentage point increase in pediatric psychiatric ED visits. They discovered that ED demand had a negligible impact on disposition status, with modest increases in demand favoring increases in discharge chance of about 1%. Instead, characteristics at the patient level were far more important in predicting discharge disposition.

Although it had little impact on disposal status, ED demand significantly impacted throughput times. To confirm the results in other state and healthcare systems, more study was required.

Reference: sciencedirect.com/science/article/pii/S0735675722007331