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Accident & emergency
Original research
Management of children visiting the emergency department during out-of-office hours: an observational study
  1. Gina Schinkelshoek1,
  2. Dorine M Borensztajn1,
  3. Joany M Zachariasse1,
  4. Ian K Maconochie2,
  5. Claudio F Alves3,
  6. Paulo Freitas4,
  7. Frank J Smit5,
  8. Johan van der Lei6,
  9. Ewout W Steyerberg7,
  10. Susanne Greber-Platzer8,
  11. Henriëtte A Moll1
  1. 1Department of General Paediatrics, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands
  2. 2Department of Paediatric Accident and Emergency, Imperial College Healthcare NHS Trust, London, UK
  3. 3Department of Paediatrics, Professor Doutor Fernando Fonseca Hospital, Amadora, Lisboa, Portugal
  4. 4Intensive Care Unit, Professor Doutor Fernando Fonseca Hospital, Amadora, Lisboa, Portugal
  5. 5Department of Paediatrics, Maasstad Hospital, Rotterdam, Zuid-Holland, The Netherlands
  6. 6Department of Medical Informatics, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
  7. 7Department of Public Health, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
  8. 8Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
  1. Correspondence to Prof. Dr. Henriëtte A Moll; h.a.moll{at}erasmusmc.nl

Abstract

Background The aim was to study the characteristics and management of children visiting the emergency department (ED) during out-of-office hours.

Methods We analysed electronic health record data from 119 204 children visiting one of five EDs in four European countries. Patient characteristics and management (diagnostic tests, treatment, hospital admission and paediatric intensive care unit admission) were compared between children visiting during office hours and evening shifts, night shifts and weekend day shifts. Analyses were corrected for age, gender, Manchester Triage System urgency, abnormal vital signs, presenting problems and hospital.

Results Patients presenting at night were younger (median (IQR) age: 3.7 (1.4–8.2) years vs 4.8 (1.8–9.9)), more often classified as high urgent (16.3% vs 9.9%) and more often had ≥2 abnormal vital signs (22.8% vs 18.1%) compared with office hours. After correcting for disease severity, laboratory and radiological tests were less likely to be requested (adjusted OR (aOR): 0.82, 95% CI 0.78–0.86 and aOR: 0.64, 95% CI 0.60–0.67, respectively); treatment was more likely to be undertaken (aOR: 1.56, 95% CI 1.49–1.63) and patients were more likely to be admitted to the hospital (aOR: 1.32, 95% CI 1.24–1.41) at night. Patterns in management during out-of-office hours were comparable between the different hospitals, with variability remaining.

Conclusions Children visiting during the night are relatively more seriously ill, highlighting the need to keep improving emergency care on a 24-hour-a-day basis. Further research is needed to explain the differences in management during the night and how these differences affect patient outcomes.

  • accident & emergency
  • general paediatrics
  • paediatric practice
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjpo-2020-000687

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    Footnotes

    • Contributors GS and DMB: conceptualisation, data curation, formal analysis, investigation, writing original draft, review and editing. JMZ: data curation, formal analysis, investigation, review and editing. SG-P, CFA, PF, FJS and IKM: data curation, investigation, review and editing. JvdL: conceptualisation, data curation, review and editing. EWS: data curation, review and editing. HAM: conceptualisation, data curation, investigation, project administration, supervision, review and editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval Medical Ethics Committee Erasmus MC: MEC-2013-567 Raad van Bestuur Maasstad Ziekenhuis: Protocol L2013-103 Joint Research Complicance Office Imperial College London and Imperial College Healthcare NHS Trust: 14/WA/1051 Comissâo de Ética para a Saúde do Hospital Prof. Dr. Fernando Fonseca, EPE: reunião 06 Dezembro de 2017 Ethik Kommission Medizinische Universität Wien: 1405/2014.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Data from this study are available upon request to the corresponding author of the study (h.a.moll@erasmusmc.nl), subject to local rules and regulations.