System Stresses in 2 Pediatric Emergency Departments and 2 Pediatric Urgent Care Centers During the 2014 Enterovirus-D68 Outbreak.
OBJECTIVE
To describe the association of an unprecedented large-scale Enterovirus-D68 outbreak in 2014 with changes in patient volume and acuity and system stress in 2 pediatric emergency departments and 2 pediatric urgent care centers of a single children's hospital.


METHODS
We compared measures of patient volume, acuity, and system stress during the 2014 Enterovirus-D68 outbreak and the corresponding dates of the previous year.


RESULTS
Both settings experienced large census increases during the Enterovirus-D68 outbreak; patient census increased significantly more in the pediatric urgent care setting (20.3%) than in the pediatric emergency departments (14.3%). Both settings had significant increases in patient acuity. The proportion of pediatric emergency department patients requiring hospital admission increased; the proportion of patients who left the pediatric urgent care setting without being seen also increased. Although there was no emergency department inpatient boarding during the 2013 comparison period, 4.4% of admitted patients required emergency department boarding during the 2014 outbreak. There was no significant change in the mean length of stay or the probability that patient admission was to the pediatric intensive care unit.


CONCLUSIONS
Both the pediatric emergency departments and the pediatric urgent care centers experienced increased patient volumes and acuity and significant system stress in association with the 2014 Enterovirus-D68 outbreak. These data will inform those planning resource allocation for future large-scale viral outbreaks.
From the Children's Mercy Hospital, Kansas City, MO.
Gregory P
GP
Conners
Stacy J
SJ
Doyle
Milton A
MA
Fowler
Lisa L
LL
Schroeder
Thomas W
TW
Tryon
D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D019352:Censuses; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D030016:Enterovirus D, Human; D004769:Enterovirus Infections / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D062072:Patient Acuity; D014481:United States / Q000453:epidemiology