The COVID-19 pandemic has transformed the healthcare delivery system over the past five years. In pediatrics, these changes include closures of pediatric units in hospitals, increasing number of children seeking care in general emergency departments and increased transfers for definitive care of common illnesses to tertiary care centers. Emergency department pediatric visits have been studied in the early pandemic period which showed overall decreased volume. Patient safety and experience have been described in the first year of the pandemic, especially related to injuries in pediatric emergency departments. The surge in volumes of pediatric emergency department visits during the late pandemic period, however, has not been well studied.
The new study by Pershad et al. in Hospital Pediatrics, “Pediatric Emergency Care Before and During the Late Pandemic Period: A National Perspective,” describes the effect of this surge on the safety, experience and proportion of low acuity non-emergency (LANE) visits (10.1542/hpeds.2024-008197). The authors conduct a retrospective cohort study to compare two groups of ED visits using the National Hospital Ambulatory Medical Care Survey (NHAMCS) data. They include all patients up to age 19 in a pre-pandemic and a late pandemic group. They report a higher mean length of stay (LOS) for patients in the late pandemic period compared to their counterparts in the pre-pandemic period. This also holds true for the proportion of patients with a prolonged LOS (greater than 4 hours) when comparing the two groups. Pershad et al., however, do not report a significant difference in the proportion of patients who left without care (LWC) or the mean door to clinician (D2C) time between the two groups. Simultaneously, the proportion of patients with D2C times greater than 60 minutes is significantly higher in the late pandemic period.
This study also reaffirms prior trends of lower injury related and higher mental visits. It also adds to the current literature by studying the operational metrics during the late pandemic period. Though the study shows that emergency departments across the United States did not see a significantly higher number of total visits, these visits consist of a significantly lower number of LANE visits. This suggests that during the late pandemic period ER visits had an overall higher acuity. The study ultimately shows a shift in trend towards higher acuity and prolonged wait times during the late pandemic period while recognizing that a thorough investigation of patient level data is needed to arrive at definitive conclusions.
The landscape of pediatric emergency visits is evolving, potentially straining emergency departments across the country. This article gives a national perspective on the operations of the emergency departments during the late pandemic period. The trends discussed in this study can help to further inform future processes of staffing, admissions, transfers and overall healthcare delivery in emergency departments.
