PC1228: Pediatric ED Saves: Analyzing the ED Screen of Direct Admissions

Purpose/Objectives: Direct admissions are a routine portal of entry to the hospital. Few and varied guidelines exist to assess patient safety during this process. The primary aim of this study was to assess the effectiveness of the Children’s Hospital of Georgia Pediatric Emergency Department (CHOG PED) screen for pediatric direct admissions. The secondary aim was to investigate variables predicting ED intervention and identification of patients transferred to the Intensive Care Unit (ICU).

Design/Methods: The CHOG PED screen is a brief evaluation of patients by a Pediatric Emergency Medicine physician and nurse. This evaluation includes a bedside assessment, vital signs review and Pediatric Early Warning Score (PEWS) calculation. Stable patients were admitted to the inpatient floor, whereas unstable patients were transferred to the ED. Charts of patients who received the ED screen between June 1, 2019 and May 31, 2020 were reviewed. Data collected included: age, sex, respiratory rate (RR), pulse oximetry (SpO2), systolic blood pressure (SBP), PEWS, diagnosis, oxygen requirement, and reason for ICU admission. Charts were placed into three groups: group 1 (stable), group 2 (unstable), and group 3 (stable then transferred to the ICU within 6 hours). To assess the ED screen’s effectiveness, sensitivity, specificity and predictive values were calculated. A one-way ANOVA, Tukey’s multiple comparison test, and Fisher’s exact test were used to explore the differences between each group. Statistical analyses were conducted at a significance level of 0.05.

Results: Of the 652 charts reviewed, 384 met inclusion criteria. The CHOG PED screen was 80% sensitive and 100% specific. The screen was able to predict 100% of unstable patients and 97.7% of stable patients. Group 1 (31.60, 26.45%, 5.23%) had significantly lower RR, respiratory diagnosis, and oxygen requirement compared to group 2 (45.00, 78.13%, 15.63%) and group 3 (44.50, 75.00%, 50.00%). For SpO2, group 1 (98.70) was significantly higher than group 2 (96.03). For PEWS, group 2 (1.72) was significantly higher than group 1 (0.31) and group 3 (0.63), respectively. There were no differences in the proportion of sex and reason for ICU admission between groups.

Conclusion/Discussion: The CHOG PED screen for direct admissions is an effective tool to identify patients in need of immediate ED intervention and/or higher level of care. Patients with a respiratory diagnosis, oxygen requirement, high RR or low SpO2 will greatly benefit from being screened by the ED prior to direct admission.