Extending the hours of a pediatric emergency department's fast track clinic into night shift did not decrease the aggregate length of stay or the length of stay of high acuity patients on night shift

Abstract

Objective: This study set out to see if extending the hours of the pediatric fast track clinic through the first half of night shift in a dedicated pediatric emergency department decreased the Length of Stay (LOS) of all the patients seen on night shift (termed aggregate LOS) and of the high acuity patients seen on night shift. Methods: This study was conducted in a pediatric hospital run by Multicare Health System in Tacoma, WA. The study was designed as a pre/post-intervention with a comparison to a similar time period the previous year. The intervention was the extension of the hours of Child Express clinic into night shift that started November 1, 2005. The pre/post intervention periods were from October 1 to October 31 and from November 1 to December 2, 2005, respectively, and for the same periods in the previous comparison year (2004). Linear regression was used to determine whether there were observable differences in mean length of stay adjusting for differential inpatient admit rates between pre and post assessment periods using a historical comparison control. Results: Mean length of stay was found to be 2.1 hours in the post intervention (Child Express) period relative to 2.32 hours in the pre-intervention period. When compared to the 2.2 hours and 2.3 hours in the respective historical periods, the difference in differences was found to be .22 hours, or 7.2 minutes (95% CI 0.84, and 1.1, p = 0.37). Conclusion: Extending the hours of the fast track clinic into night shift was not associated with a difference in aggregate LOS or the LOS of high acuity patients on night shift. This is consistent with previous findings. Additional factors likely influence the throughput of a pediatric emergency department beyond simply reducing the volume of low acuity patients in the main emergency room.