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Prediction of Acuity Using EMS Pre-Notifications in a Pediatric Emergency Department

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Prediction of Acuity Using EMS Pre-Notifications in a Pediatric Emergency Department
Kristy Williamson, MD, Francesca Bullaro, MD, Robert Gochman, MD, Bradley Kaufman, MD, Daniel Jun, BA and William Krief, MD, NSLIJ/Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park NY

Background: EMS pre-notifications regarding the pending arrival of ill patients are important for preparation and appropriate resource allocation in a busy ED. Frequently, pre-notifications inaccurately convey the patient's true acuity, leading to inappropriate allocation of staff, space, and resources. The objective of this study is to determine if predicted patient acuity based on pre-notifications by EMS differs from actual patient acuity on arrival to the Pediatric ED. Methods: ED physicians were trained to use the Emergency Severity Index (ESI), a reliable method for triaging patients based on acuity and resource allocation. A physician calculated the predicted ESI before patient arrival based solely on the pre-notification information, then calculated the actual ESI within 30 minutes. The actual ESI documented by a triage nurse was also included. Descriptive statistics were calculated, and comparisons were performed using Wilcoxon signed rank for matched pairs. Results: Data were collected prospectively from over 1 year, and a total of 100 patients were enrolled. The median physician predicted ESI was 2, whereas the median actual ESI was 3. There are statistically significant differences between the predicted and actual ESI made by physicians (p=0.0001) and between the actual scores by physicians and nurses (p<0.001). For 46 patients, the predicted and actual scores were the same, but 13% were “undertriaged” and 41% were “overtriaged” based on predicted ESI. Conclusions: There are statistically significant differences between predicted and actual acuity of patients arriving to a pediatric ED based on EMS prenotifications, potentially affecting patient care and appropriate resource allocation.

Objective: At the end of this activity, the learner will be able to discuss the importance and usefulness of EMS pre-notifications to the Pediatric Emergency Department in terms of their ability to predict patient acuity and appropriate preemptive resource allocation.

Objective Content: Comparisons between predicted and actual acuity level based on pre-notifications were performed in order to assess the usefulness of EMS communication regarding the pending arrival of medically ill and trauma patients.


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