Plan for Your Patient Mix

The data in Table 1 reflect the real differences in the characteristics of pediatric and adult patients. Adult patients are generally higher acuity, arrive much more frequently by ambulance, require more diagnostic testing (and subsequently more time in the emergency department), and get admitted at a much higher rate.

(click for larger image) Table 1: EDBA 2017 Data Survey of Adult vs. Pediatric ED Characteristics

Diagnostic test utilization is particularly important for ED planning. EDBA reports on ED utilization of diagnostic imaging, measured in the number of procedures performed per 100 patients seen. So a patient having multiple imaging procedures done (eg, a hip X-ray and a chest X-ray) would have two procedures in the EDBA reporting system. Utilization of CT scans appears to have peaked in the EDBA data survey. However, utilization remains higher in emergency departments that are high-level trauma centers and see more adult patients. Pediatric emergency departments only use CT imaging about four times per 100 patients seen. There are smaller differences in adult and pediatric utilization of ultrasound and MRIs.

The analysis shows that emergency departments that see adult patient populations generally have higher acuity, more EMS arrivals, higher admission rates, and longer processing times. The use of ECGs as a diagnostic modality is at least 10 times higher in adult patients.

It is critical that emergency physicians and ED leaders appreciate and plan for the patients who will be seen. This includes an appreciation of the differences in patient characteristics between pediatric and adult patients. The planning process is most important in community emergency departments that serve all age groups but are likely seeing an increasing percentage of older patients with higher acuity needs.

References

1. The Emergency Department Benchmarking Alliance data report for 2017. EDBA website. Accessed Jan. 11, 2019.
2. National Hospital Ambulatory Medical Care Survey: 2015 emergency department summary tables. CDC website. Accessed Jan. 11, 2019.