Dedicated pediatricians in emergency department: shorter waiting times and lower costs

<strong>Background</strong> Dedicated pediatricians in emergency departments (EDs) may be beneficial, though no previous studies have assessed the related costs and benefits/harms. We aimed to evaluate the net benefits and costs of dedicated emergency pediatricians in a pediatric ED. <strong>Methods</strong> Cost-consequences analysis of visits to a pediatric ED of a tertiary hospital. Two pediatric ED Medical Teams (MT) were compared: MT-A (May–September 2012), with general pediatrics physicians only; and MT-B (May–September 2013), with emergency dedicated pediatricians. The main outcomes analyzed were relevant clinical outcomes, patient throughput time and costs. <strong>Results</strong> We included 8,694 children in MT-A and 9,417 in MT-B. Medication use in the ED increased from 42.3% of the children in MT-A to 49.6% in MT-B; diagnostic tests decreased from 24.2% in MT-A to 14.3% in MT-B. Hospitalization increased from 1.3% in MT-A to 3.0% in MT-B; however, there was no significant difference in diagnosis-related group relative weight of hospitalized children in MT-A and MT-B (MT-A, 0.979; MT-B, 1.075). No differences were observed in ED readmissions or in patients leaving without being seen by a physician. The patient throughput time was significantly shorter in MT-B, with faster times to first medical observation. Within the cost domains analyzed, the total expenditures per children observed in the ED were 16% lower in MT-B: 37.87 euros in MT-A; 31.97 euros in MT-B. <strong>Conclusion </strong>The presence of dedicated emergency pediatricians in a pediatric ED was associated with significantly lower waiting times in the ED, reduced costs, and similar clinical outcomes.

背景 急诊科（emergency departments, ED）配备专职急诊儿科医师或可带来临床获益，但目前尚无研究评估其相关成本与获益/损害。本研究旨在评估儿科急诊科内专职急诊儿科医师的净获益与医疗成本。方法 本研究针对某三级医院儿科急诊科的就诊病例开展成本后果分析。对比两组儿科急诊医疗团队（medical team, MT）：MT-A组（2012年5月—9月）仅配备普通儿科医师；MT-B组（2013年5月—9月）配备专职急诊儿科医师。本研究的主要分析结局包括相关临床指标、患者周转时间与医疗成本。结果 本研究共纳入MT-A组患儿8694例，MT-B组患儿9417例。急诊科用药率从MT-A组的42.3%升至MT-B组的49.6%；诊断检查率从MT-A组的24.2%降至MT-B组的14.3%。住院率从MT-A组的1.3%升至MT-B组的3.0%；但两组住院患儿的诊断相关分组（diagnosis-related group, DRG）相对权重无显著差异（MT-A组：0.979；MT-B组：1.075）。两组的急诊科再入院率及未就诊离院率均无显著差异。MT-B组的患者周转时间显著缩短，首次接诊时间更快。在本次分析的成本维度中，儿科急诊科每位就诊患儿的总支出较MT-A组降低16%：MT-A组为37.87欧元，MT-B组为31.97欧元。结论 儿科急诊科配备专职急诊儿科医师，可显著缩短急诊科等候时间、降低医疗成本，且临床结局无显著差异。