title: The effect of emergency department crowding on reassessment of children with critically abnormal vital signs.
abstract: OBJECTIVE
  The objective was to determine whether several measures of emergency department (ED) crowding are associated with an important indicator of quality and safety: time to reevaluation of children with documented critically abnormal triage vital signs.
  
  
  METHODS
  This was a retrospective cross-sectional study of all patients with critically abnormal vital signs measured in triage over a 2.5-year period (September 1, 2006, to May 1, 2009). Cox proportional hazard analysis was used to determine rate ratios for time to critically abnormal vital sign reassessment, when controlled for potential confounders.
  
  
  RESULTS
  In this 2.5-year sample, 9,976 patients with critically abnormal vital signs in triage (representing 3.9% of 253,408 visits) were placed in regular ED rooms with electronic alerts prompting vital sign reassessment after 1 hour. Overall, the mean time to reassessment was 84 minutes. The rate of vital sign reassessment was reduced by 31% for each additional 10 patients waiting for admission (adjusted odds ratio [OR] = 0.98; 95% confidence interval [CI] = 0.98 to 0.99), by 10% for every 10 patients in the lobby (adjusted OR = 0.94; 95% CI = 0.93 to 0.96), and by 6% for every additional 10 patients in the overall ED census (adjusted OR = 0.97; 95% CI = 0.97 to 0.98).
  
  
  CONCLUSIONS
  Emergency department crowding was associated with delay in the reassessment of critically abnormal vital signs in children; further work is needed to develop systems to mitigate these delays.
authors.affiliation: The Division of Emergency Medicine, Department of Clinical Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Holly E
authors.initials: HE
authors.lastname: Depinet
authors.forename: Srikant B
authors.initials: SB
authors.lastname: Iyer
authors.forename: Richard
authors.initials: R
authors.lastname: Hornung
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Timm
authors.forename: Terri L
authors.initials: TL
authors.lastname: Byczkowski
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy*; D003430:Cross-Sectional Studies; D003441:Crowding; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009820:Ohio; D012189:Retrospective Studies; D013997:Time Factors; D014218:Triage; D055986:Vital Signs; D055815:Young Adult