Presented at the Pediatric Academic Societies annual meeting, Honolulu HI, May 2008, and the Pediatric Academic Societies annual meeting, Baltimore MD, May 2009.
Original Research Contribution
Emergency Department Crowding Is Associated with Decreased Quality of Analgesia Delivery for Children with Pain Related to Acute, Isolated, Long-bone Fractures
Article first published online: 13 DEC 2011
© 2011 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Special Issue: Proceedings of the 2011 AEM Consenus Conference: Interventions to Assure Quality in the Crowded Emergency Department Guest Editors: James R. Miner, MD Manish N. Shah, MD, MPH
Volume 18, Issue 12, pages 1330–1338, December 2011
How to Cite
Sills, M. R., Fairclough, D. L., Ranade, D., Mitchell, M. S. and Kahn, M. G. (2011), Emergency Department Crowding Is Associated with Decreased Quality of Analgesia Delivery for Children with Pain Related to Acute, Isolated, Long-bone Fractures. Academic Emergency Medicine, 18: 1330–1338. doi: 10.1111/j.1553-2712.2011.01136.x
MRS, DLF, and DR received support from the Agency for Healthcare Research and Quality (5R03HS016418) and the Emergency Medicine Foundation.
MRS was supported by the Riggs Family/Health Policy Grant from the American College of Emergency Physicians, Grant 1 R03 HS016418-01A1 from the Agency for Healthcare Research and Quality and by the Children’s Hospital Research Institute.
The authors have no relevant financial information or potential conflicts of interest to disclose.
Supervising Editor: James W. Fox, MD.
- Issue published online: 13 DEC 2011
- Article first published online: 13 DEC 2011
- Received November 6, 2010; revision received January 4, 2011; accepted January 18, 2011.
ACADEMIC EMERGENCY MEDICINE 2011; 18:1330–1338 © 2011 by the Society for Academic Emergency Medicine
Objectives: The authors sought to determine which quality measures of analgesia delivery are most influenced by emergency department (ED) crowding for pediatric patients with long-bone fractures.
Methods: This cross-sectional, retrospective study included patients 0–21 years seen for acute, isolated long-bone fractures, November 2007 to October 2008, at a children’s hospital ED. Nine quality measures were studied: six were based on the timeliness (1-hour receipt) and effectiveness (receipt/nonreceipt) of three fracture-related processes: pain score, any analgesic, and opioid analgesic administration. Three equity measures were also tested: language, identified primary care provider (PCP), and insurance. The primary independent variable was a crowding measure: ED occupancy. Models were adjusted for age, language, insurance, identified PCP, triage level, ambulance arrival, and time of day. The adjusted risk of each timeliness or effectiveness quality measure was measured at five percentiles of crowding and compared to the risk at the 10th and 90th percentiles. The role of equity measures as moderators of the crowding-quality models was tested.
Results: The study population included 1,229 patients. Timeliness and effectiveness quality measures showed an inverse association with crowding—an effect not moderated by equity measures. Patients were 4% to 47% less likely to receive timely care and were 3% to 17% less likely to receive effective care when each crowding measure was at the 90th than at the 10th percentile (p < 0.05). For three of the six quality measures, quality declined steeply between the 75th and 90th crowding percentiles.
Conclusions: Crowding is associated with decreased timeliness and effectiveness, but not equity, of analgesia delivery for children with fracture-related pain.