title: Dedicated Pediatricians in Emergency Department: Shorter Waiting Times and Lower Costs.
abstract: BACKGROUND
  Dedicated pediatricians in emergency departments (EDs) may be beneficial, though no previous studies have assessed the related costs and benefits/harms. We aimed to evaluate the net benefits and costs of dedicated emergency pediatricians in a pediatric ED.
  
  
  METHODS
  Cost-consequences analysis of visits to a pediatric ED of a tertiary hospital. Two pediatric ED Medical Teams (MT) were compared: MT-A (May-September 2012), with general pediatrics physicians only; and MT-B (May-September 2013), with emergency dedicated pediatricians. The main outcomes analyzed were relevant clinical outcomes, patient throughput time and costs.
  
  
  RESULTS
  We included 8,694 children in MT-A and 9,417 in MT-B. Medication use in the ED increased from 42.3% of the children in MT-A to 49.6% in MT-B; diagnostic tests decreased from 24.2% in MT-A to 14.3% in MT-B. Hospitalization increased from 1.3% in MT-A to 3.0% in MT-B; however, there was no significant difference in diagnosis-related group relative weight of hospitalized children in MT-A and MT-B (MT-A, 0.979; MT-B, 1.075). No differences were observed in ED readmissions or in patients leaving without being seen by a physician. The patient throughput time was significantly shorter in MT-B, with faster times to first medical observation. Within the cost domains analyzed, the total expenditures per children observed in the ED were 16% lower in MT-B: 37.87 euros in MT-A; 31.97 euros in MT-B.
  
  
  CONCLUSIONS
  The presence of dedicated emergency pediatricians in a pediatric ED was associated with significantly lower waiting times in the ED, reduced costs, and similar clinical outcomes.
authors: Department of Pediatrics, Integrated Pediatric Hospital, Centro Hospitalar de S. João, Porto, Portugal.|Institute of Public Health, University of Porto, Porto, Portugal.
authors: Manuel Rocha
authors: MR
authors: Melo
authors: Department of Pediatrics, Integrated Pediatric Hospital, Centro Hospitalar de S. João, Porto, Portugal.|Center for Health Technologies and Information Systems Research, Faculty of Medicine, University of Porto, Porto, Portugal.
authors: Manuel
authors: M
authors: Ferreira-Magalhães
authors: Department of Pediatrics, Integrated Pediatric Hospital, Centro Hospitalar de S. João, Porto, Portugal.
authors: Filipa
authors: F
authors: Flor-Lima
authors: Department of Pediatrics, Integrated Pediatric Hospital, Centro Hospitalar de S. João, Porto, Portugal.
authors: Mariana
authors: M
authors: Rodrigues
authors: Institute of Public Health, University of Porto, Porto, Portugal.|Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Portugal.
authors: Milton
authors: M
authors: Severo
authors: Department of Pediatrics, Integrated Pediatric Hospital, Centro Hospitalar de S. João, Porto, Portugal.
authors: Luis
authors: L
authors: Almeida-Santos
authors: Department of Pediatrics, Integrated Pediatric Hospital, Centro Hospitalar de S. João, Porto, Portugal.|Institute of Public Health, University of Porto, Porto, Portugal.
authors: Alberto
authors: A
authors: Caldas-Afonso
authors: Lisbon Nova University, Lisboa, Portugal.|Centre for Economic Policy Research, London, United Kingdom.
authors: Pedro Pita
authors: PP
authors: Barros
authors: Centro Hospitalar de S. João, Porto, Portugal.
authors: António
authors: A
authors: Ferreira
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D005102:Health Expenditures; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D010359:Patient Readmission; D010372:Pediatrics / Q000191:economics*; D011174:Portugal; D010818:Practice Patterns, Physicians'; D013997:Time Factors; D000078329:Workforce