The quality of children's asthma care is affected by emergency department crowding
Children seen at a crowded emergency department (ED) for acute asthma are less likely to receive timely and effective care than when the ED is less crowded, according to a new study. The care received is not influenced by equity measures such as insurance status or having a primary care provider. Studies in adults have found ED crowding to be widespread and a threat to quality of care for heart attacks and hospitalized cases of pneumonia, but these conditions are less common among children, the researchers note. They extracted data from a children's hospital electronic medical record system for visits for acute asthma to the hospital's pediatric ED from November 2007 through October 2008.
The measures of timely care were the percentage of children with acute asthma receiving an asthma score, beta-agonist, or steroid within the first hour after arrival. Effective care was measured by the percentage of patients receiving an asthma score and the percentage receiving a steroid during their visit. The researchers found that patients were 52 to 74 percent less likely to receive timely care—and were 9 to 14 percent less likely to receive effective care—when the pediatric ED was at the 75th percentile of the crowding measure than when it was at the 25th percentile.
Comparable results came when the number of children waiting to see the attending physician was used as the crowding measure. Data was also analyzed for the 90th and 10th percentiles of crowding, and indicated, as expected, a greater difference in quality of care when measured across a greater range of crowding. The study was funded in part by the Agency for Healthcare Research and Quality (HS16418).
More details are in "Emergency department crowding is associated with decreased quality of care for children with acute asthma," by Marion R. Sills, M.D., M.P.H., Diane Fairclough, Dr.P.H., Daksha Ranade, M.S.P.H., M.B.A., and Michael G. Kahn, M.D., Ph.D., in the March 2011 Annals of Emergency Medicine 57(3), pp. 191-200.
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