A recent study examining over 2.7 million pediatric emergency department (ED) visits in Michigan revealed varying standards of pediatric emergency care in different EDs due to the increasing influx of children with viral and respiratory illnesses between September 1 and December 31, 2022.
Published on December 7 in JAMA Network Open, the retrospective study involved 25 emergency physicians participating in the Michigan Emergency Department Improvement Collaborative (MEDIC). The study analyzed wait times, length of stay (LOS), and readmission rates in the emergency department for children (aged <18 years) presenting with acute viral and respiratory illnesses at different emergency department facilities, including children's hospitals, urban pediatric emergency departments with high volume (≥10% of total visits), urban pediatric emergency departments with low volume (<10% of total visits), and rural emergency departments. The increase in pediatric visits represented a 71.8% increase compared to the previous four months and a 15.7% increase compared to the same period in 2021. During this surge, children's hospitals faced significant challenges. Approximately 8.0% of visits experienced prolonged wait times of more than 4 hours, 8.6% experienced longer LOS of more than 12 hours, and 42 readmissions were recorded per 1000 emergency department visits. Dr. Alexander Janke, MD, MHS, Assistant Professor of Emergency Medicine at the Yale University School of Medicine and Fellow in the National Clinicians Scholars Program at the University of Michigan Medical News of Medscape, explained, "Long wait times are essentially due to a lack of actual treatment areas (e.g. spaces in the emergency department) and available treatment staff (particularly nurses). When inpatient beds are full, this leads to overcrowding in emergency departments, making it difficult for emergency department physicians to treat new patients as they arrive." While prolonged wait times were rare at other emergency department locations, the surge impacted different emergency departments: 2.2% of visits in high-volume urban pediatric emergency departments, 2.6% in low-volume urban pediatric emergency departments, and 3.1% in rural emergency departments experienced prolonged LOS. The surge highlighted that compared to other emergency departments, children's hospitals faced significant operational burdens. Collaborative relationships between children's hospitals, community emergency departments, rural facilities, and outpatient pediatric practices are critical to ensuring effective clinical management pathways and quality measures during periods of increased demand. Additionally, the results emphasized the urgency to address inequalities in access and quality of care, urging policymakers and healthcare leaders to consider the financial and operational aspects of pediatric acute care. The study underscored the reward and preparation for an increase in care needs and called for concerted efforts to ensure timely and high-quality care for all children in various healthcare facilities. Dr. Janke also pointed out, "A major challenge we face is that it can be financially difficult for hospitals to maintain pediatric inpatient beds. That means when the surge hits, there are not enough beds available to meet the demand. We need a financial model for pediatric care that ensures comprehensive pediatric readiness and emergency preparedness, so that all children receive the best possible care in times of illness."