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Emergency Medicine

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Emergency departments with physician residents are less effective in determining which children require hospital admission

More than 30 million children are treated in U.S. hospital emergency departments (EDs) each year. EDs staffed with physician residents in training are less effective in determining which children require hospital admission and which can be safely released, concludes a new study. EDs with residents admitted children at a rate nearly 14 times higher than expected compared with nonresident hospitals, after adjusting for children's illness severity. EDs with residents also had far more children returning to the ED within 72 hours after discharge, an indicator that they were discharged from the ED prematurely.

Volume of patients and physician specialist status were not associated with hospital admissions or return to the ED within 72 hours. These results are consistent with the known liabilities of care by less experienced physician residents. For example, use of pediatric residents has been associated with higher rates of ED medication errors, higher mortality rates, and longer stays in the intensive care unit (ICU). The findings were based on an examination of 3 ED care factors for 16 hospitals with pediatric ICUs: annual pediatric volume, presence or absence of pediatric emergency medicine specialists, and presence or absence of ED residents.

A Pediatric Risk of Admission Score measured illness severity. The researchers compared observed with predicted (based on illness severity) hospital admissions and returns to the ED within 72 hours for 11,664 children. Compared with nonresident hospitals, resident hospitals had about 18 times more children than expected either admitted to the hospital or returned within 72 hours (35.5 vs. 1.9 per 1,000 patients). The study was supported by the Agency for Healthcare Research and Quality (HS10238).

See "Association of emergency department care factors with admission and discharge decisions for pediatric patients," by James M. Chamberlain, M.D., Kantilal M. Patel, Ph.D., and Murray M. Pollack, M.D., M.B.A., in the Journal of Pediatrics 149, pp. 644-649, 2006.

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