The impact of critically ill children on paediatric ED medication timeliness. Issue 1 (28th September 2016)

• Record Type: Journal Article
• Authors: Michelson, Kenneth A; Bachur, Richard G; Levy, Jason A
• Is Part Of: Emergency medicine journal. Volume 34:Issue 1(2017)
• Page Start: 8
• Page End: 12
• Publication Date: 2016-09-28
• Subjects: emergency department -- paediatrics -- emergency department operations; Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emermed-2016-205989
• Languages: English
• ISSNs: 1472-0205

Abstract

Abstract : 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 3 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 170 112 visits. Median times to first medication for those exposed to 0, 1 and >1 simultaneous critically ill patients were 90 min (IQR 54–146), 96 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 6 min (IQR 2–14, p=0.11) and in time to antibiotic for fever/neutropenia was −4 min (IQR −4 to −11, p=0.13). Modelled time to first medication increased 3.1 min (95% CI 0.5 to 5.7) among all exposed patients (p=0.02). Time to first medication increased 15.3 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.