Pediatric Risk of Admission (PRISA): A Measure of Severity of Illness for Assessing the Risk of Hospitalization From the Emergency Department☆,☆☆,★
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INTRODUCTION
Intensive care and trauma systems have benefited from the development and use of severity assessment methods, using mortality as the primary outcome. For example, methods of measuring severity in the pediatric ICU (PICU) have enabled evaluation of quality using severity-adjusted mortality rates,1 identification of care characteristics associated with quality of care,2, 3 assessment of efficiency of bed use,4, 5 and prediction of length of stay.6 Similar studies have been performed for trauma
MATERIALS AND METHODS
The study was performed at Children’s National Medical Center, an urban, university-affiliated, nonprofit, private hospital providing primary, secondary, and tertiary care for the District of Columbia and surrounding metropolitan area. The average annual ED patient census is 54,000. Patients are triaged by a registered nurse with pediatric emergency experience and are medically evaluated by house staff (first-, second-, and third-year residents in pediatrics, emergency medicine, and family
RESULTS
There were 21,288 ED visits during the study period. After exclusion of patients with minor injuries and those triaged to the nonurgent clinic, the 25% randomization resulted in a sample of 2,683 patients. The median age was 64 months, with a range of 2 days to 24 years. Other patient characteristics are shown in Table 1. A total of 15.2% of these children arrived by emergency medical transport (ambulance, helicopter), and 25.8% were referred from either physician offices or other EDs. Chief
DISCUSSION
EDs treat approximately 27 million children per year, of whom 5% are admitted to hospitals.9 Large tertiary care centers admit 10% to 15% of pediatric ED patients. Despite the large volume of pediatric patients and the costs associated with this treatment, little has been done to measure the quality of ED care, particularly with regard to patient outcomes. Structure has been assessed by comparing rates of board certification of physicians.27 Process of ED care measures have included patient
References (36)
- et al.
Variability in duration of stay in pediatric intensive care units: A multiinstitutional study
J Pediatr
(1996) - et al.
The pediatric trauma score as a predictor of injury severity in the injured child
J Pediatr Surg
(1987) - et al.
The reliability and validity of the pediatric appropriateness evaluation protocol
Qual Rev Bull
(1989) - et al.
Emergency medicine credentials in St Louis and Kansas City: Does the presence of an emergency residency program have a geographic difference?
Ann Emerg Med
(1996) - et al.
Impact of an emergency medicine residency program on the quality of care in an urban community hospital emergency department
Ann Emerg Med
(1992) - et al.
Attending physician coverage in a teaching hospital’s emergency department: Effect on malpractice
J Emerg Med
(1994) - et al.
Improved outcomes from tertiary center, pediatric intensive care: A statewide comparison of tertiary and nontertiary care facilities
Crit Care Med
(1991) - et al.
Impact of quality-of-care factors on pediatric intensive care unit mortality
JAMA
(1994) - et al.
Improving the outcome and efficiency of pediatric intensive care: The impact of an intensivist
Crit Care Med
(1988) - et al.
Resource use, efficiency, and outcome prediction in pediatric intensive care of trauma patients
J Trauma
(1990)
Efficiency intensive care: A comparative analysis of eight pediatric intensive care units
JAMA
The predictive validity of the pediatric trauma score
J Trauma
National Hospital Ambulatory Medical Survey: 1993 Emergency Department Summary. Advance Data from Vital and Health Statistics, no 271
US emergency department costs: No emergency
Am J Public Health
Reliability of measurement
Medically inappropriate hospital use in a pediatric population
N Engl J Med
Inappropriate use of hospitals in a random trial of health insurance plans
N Engl J Med
Appropriateness of hospitalization in a Canadian pediatric hospital
Pediatrics
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2007, Annals of Emergency MedicineCitation Excerpt :The “error types”1,15 were categorized as shown in the Figure and included medication given but not ordered; medication ordered but not given; wrong drug given from what was ordered; wrong dose; wrong or inappropriate drug for condition; wrong administration technique, wrong route; wrong dosage form; wrong time; and error related to patient information. Although “medication given but not ordered” likely includes verbal orders, these are still considered medication errors by the National Coordinating Council for Medication Error Reporting and Prevention, United States Pharmacopeia, and the Joint Commission on Accreditation of Healthcare Organizations.1,15,16 The other types of errors identified by the National Coordinating Council for Medication Error Reporting and Prevention and previous authors (ie, wrong frequency, transcription, wrong patient, illegible order, or wrong date) were considered either not applicable to the ED setting or not ascertainable by retrospective medical record review.1,17
Infant and toddler disease score was useful for risk of hospitalization based on data from administrative claims
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2006, Archives de Pediatrie
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From the George Washington University School of Medicine and Health Sciences,* Children’s National Medical Center,‡ and National Institute on Alcohol Abuse and Alcoholism, The National Institutes of Health,§ Washington DC.
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Reprint no. 47/1/91519
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Address for reprints: James M Chamberlain, MD Emergency Medicine Children’s Hospital National Medical Center 111 Michigan Avenue, NW Washington DC 20010 202-884-4177 Fax 202-884-3573 E-mail [email protected]