Friday, August 15, 2014

Variation in Pediatric Emergency Department Admissions Rates

Pediatrics Editorial Board Member Joann Schulte, DO, MPH, shares her expert perspective on a new article from our September issue. To learn more about Dr. Schulte and her work in general pediatrics and preventive medicine, check out her bio on our Contributors page.

By: Joann Schulte, DO, MPH

Photo by Dana Beveridge via Flickr
To admit or not to admit is the question in the pediatric emergency room. Some children are deposited into the waiting line at the ER because there’s no primary care provider available. Others roll in with the siren blaring and an escort of paramedics. Which children go home and which stay to be admitted varies greatly according to new research published in the September issue of Pediatrics.

Four researchers at Boston Children’s Hospital led by Dr. Florence Bourgeois (doi: 10.1542/peds.2014-1278) looked at data for a 3-year period ending in 2012, examining variation in admissions to tertiary pediatric hospitals. Using data from the Pediatric Hospital Information System, an administrative database containing information about pediatric admissions and visits, the researchers focused on seven common diagnoses that could be serious, resulting in admissions approximately 10 percent of the time: asthma, cellulitis, bronchiolitis, pneumonia, kidney infections, seizures and concussions.

Wide variations in admissions were found for concussion (between 5 and72 percent), pneumonia (19 to 69 percent) and bronchiolitis (19 to 65 percent). Such differences might be related to the patient population, practice patterns of physicians and availability of care in other settings.

Understanding the variation in care is an important part of providing the best care for children. Such research is also important in understanding factors associated with admissions, which is a more expensive form of care. In 2006, the median daily cost for a pediatric admission was estimated to be $3,000.

How do the admission rates reported in this study compare to those at your hospital? Leave a comment, or join in the discussion over on our journal's website, Facebook or Twitter.

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