Weiner Scott G, Ruffing Ronald P, Barnewolt Brien A
Research, Tufts Medical Center Emergency Department, Tufts Medical Center, Tufts Medical School, Boston, MA, USA.
Pediatr Emerg Care. 2012 Sep;28(9):869-72. doi: 10.1097/PEC.0b013e31826763bc.
Pediatric patients in the emergency department (ED) are typically seen either by general emergency physicians (EPs) or by pediatric emergency physicians (PEPs) who have completed either a fellowship in pediatric emergency medicine or both pediatric and emergency medicine residencies. This study evaluates admission rates, turnaround times, and test and medication utilization for EPs versus PEPs.
A retrospective chart analysis was conducted at an academic tertiary care hospital with a dedicated pediatric ED. When the pediatric ED is open (from noon to midnight), it is always staffed with dedicated pediatric nurses and residents. In our ED, the only variable is the attending physician, who can either be an EP or a PEP. All visits for patients younger than 18 years who presented during the time the pediatric ED was open from July 1, 2007, to June 30, 2010, were eligible for inclusion. Only patients seen by physicians who saw more than 400 patients during this period were included. Disposition outcomes for patients who were either admitted or discharged were compared between EPs and PEPs. Complete blood count, Chem 7, urinalysis, chest radiography ordering rates, and intravenous fluid and ondansetron administration were used as surrogates for general conclusions about test utilization.
There were 13,347 patient visits eligible for inclusion, of which 8330 (62.4%) were seen by 2 PEPs, and 5017 (37.6%) were seen by 9 EPs. There was a difference in mean patient age (6.9 vs 7.1 years, P = 0.01), whereas sex (53.6% vs 53.9% male, P = 0.72), race (P = 0.13), acuity (mean Emergency Severity Index 3.35 vs 3.33, P = 0.99), and mode of arrival (10.6% vs 12.3% emergency medical services transport, P = 0.06) were not significantly different. Overall admission rates were similar (17.1% PEP vs 17.5% EP, P = 0.50), as were critical care admissions (2.9% PEP vs 2.7% EP of total admissions, P = 0.40). Turnaround times were significantly different (146.0 ± 2.5 minutes PEP vs 149.7 ± 3.2 minutes EP, P = 0.04). Ordering rates of Chem 7, urinalyses, chest radiographs, and ondansetron were lower by PEPs.
In our pediatric ED, which represents a natural experiment where the type of physician is the only variable, PEPs and EPs have similar rates of admission to floor beds and critical care. Pediatric EPs are slightly faster at throughput and order fewer tests and medication.
急诊科的儿科患者通常由普通急诊医师（EP）或儿科急诊医师（PEP）诊治，后者已完成儿科急诊医学专科培训或儿科与急诊医学住院医师培训。本研究评估了EP与PEP的收治率、周转时间以及检查和药物使用情况。
在一家设有专门儿科急诊科的学术型三级医疗机构进行回顾性病历分析。儿科急诊科开放时（中午至午夜），始终配备专门的儿科护士和住院医师。在我们的急诊科，唯一的变量是主治医生，其可以是EP或PEP。纳入2007年7月1日至2010年6月30日儿科急诊科开放期间就诊的所有18岁以下患者。仅纳入在此期间诊治患者超过400例的医生所诊治的患者。比较了EP和PEP诊治的患者的出院结局。全血细胞计数、七项血液生化检查、尿液分析、胸部X线检查的开具率以及静脉输液和昂丹司琼的使用情况被用作检验利用总体结论的替代指标。
有13347例患者就诊符合纳入标准，其中8330例（62.4%）由2名PEP诊治，5017例（37.6%）由9名EP诊治。患者平均年龄存在差异（6.9岁对7.1岁，P = 0.01），而性别（男性分别为53.6%对53.9%，P = 0.72）、种族（P = 0.13）、病情严重程度（平均急诊严重程度指数3.35对3.33，P = 0.99）以及到达方式（急诊医疗服务转运分别为10.6%对12.3%，P = 0.06）无显著差异。总体收治率相似（PEP为17.1%，EP为17.5%，P = 0.50），重症监护收治率也相似（分别占总收治患者的2.9%对2.7%，P = 0.40）。周转时间存在显著差异（PEP为146.0±2.5分钟，EP为149.7±3.
