title: Pediatric emergency department management benefits from appropriate early redirection of nonurgent visits.
abstract: OBJECTIVE
  Overcrowding at pediatric emergency departments (EDs) may result in delayed clinical management and higher risks of medical error. This study was designed to prospectively evaluate what parents of sick children seek emergency care for and how these patients are being assessed and managed.
  
  
  METHODS
  Patients aged 0 to 17 years seeking ED care at an urban Swedish university hospital, from 8 AM to 9 PM on 25 consecutive days, were included. Clinical urgency and further level of medical care were determined by experienced nurses based on individual clinical signs and vital parameters. Information on presenting problem, medical priority, gender, age, waiting time, day of week, time of day, and further management was recorded.
  
  
  RESULTS
  Among 1057 included children, two thirds were assessed by physicians, whereas one third were referred directly by nurses for other ED (n = 54) or primary care (n = 114), or sent home with medical advice (n = 176), more often during evenings and weekends. Of primarily referred patients, 7.6% returned within 72 hours, and three of them were admitted. Young infants, patients with respiratory or neurological problems, and sicker patients with fever or infections were mainly assessed by physicians, within desired priority time.
  
  
  CONCLUSIONS
  More than one fourth of pediatric ED patients might rapidly, appropriately, and safely be referred for primary care or sent home by experienced pediatric nurses soon after arrival, thereby facilitating management of urgent and more appropriate patients. Evaluations by physicians were primarily required in young infants and for urgent medical conditions demanding qualified pediatric skills.
authors: From the Department of Clinical Sciences Malmö, *Anesthesiology and Intensive Care Medicine, and †Pediatrics, Lund University, Skåne University Hospital, Malmö, Sweden.
authors: Julia
authors: J
authors: Ellbrant
authors: Jonas
authors: J
authors: Åkeson
authors: Pia Karlsland
authors: PK
authors: Åkeson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D013997:Time Factors; D014218:Triage / Q000458:organization & administration*