Implementation of a Pediatric Emergency Triage System in Xiamen, China.

BACKGROUND: Pediatric emergency rooms (PERs) in Chinese hospitals are perpetually full of sick and injured children because of the lack of sufficiently developed community hospitals and low access to family physicians. The aim of this study was to evaluate the clinical value of a new five-level Chinese pediatric emergency triage system (CPETS), modeled after the Canadian Triage System and Acuity Scale. METHODS: In this study, we compared CPETS outcomes in our PER relative to those of the prior two-level system. Patients who visited our PER before (January 2013-June 2013) and after (January 2014-June 2014) the CPETS was implemented served as the control and experimental group, respectively. Patient flow, triage rates, triage accuracy, wait times (overall and for severe patients), and patient/family satisfaction were compared between the two groups. RESULTS: Relative to the performance of the former system experienced by the control group, the CPETS experienced by the experimental group was associated with a reduced patient flow through the PER (Cox-Stuart test, t = 0, P < 0.05), a higher triage rate (93.40% vs. 90.75%; χ2 = 801.546, P < 0.001), better triage accuracy (96.32% vs. 85.09%; χ2 = 710.904, P < 0.001), shorter overall wait times (37.30 ± 13.80 min vs. 41.60 ± 15.40 min; t = 11.27, P < 0.001), markedly shorter wait times for severe patients (2.07 [0.65, 4.11] min vs. 3.23 [1.90,4.36] min; z = -2.057, P = 0.040), and higher family satisfaction rates (94.23% vs. 92.21%; χ2 = 321.528, P < 0.001). CONCLUSIONS: Implementing the CPETS improved nurses' abilities to triage severe patients and, thus, to deliver the urgent treatments more quickly. The system shunted nonurgent patients to outpatient care effectively, resulting in improved efficiency of PER health-care delivery.

Impact of follow-up calls from the pediatric emergency department on return visits within 72 hours: a randomized controlled trial.

OBJECTIVES: We compare the rate of return to the emergency department (ED) within 72 hours between families of children receiving a follow-up telephone call by a non-health care provider asking about the child's well-being 12 hours after their visit to the ED and families not receiving a follow-up call. METHODS: This was a prospective, randomized study in which we conducted a follow-up call starting at 12 hours after discharge from the ED versus no call for follow-up. At 96 hours after discharge, we contacted all recruited families. We recorded the rate of return to the ED within 72 hours of discharge. RESULTS: Of 371 families in the data analysis, 46% were in the study group, and 55.5% were male patients. Mean age was 5.7 years. The outcome measure was found to be in contrary to our hypothesis. We found return visits to the ED in 24 (14%) of the children in the study group compared with only 14 (7%) in the control group (P < 0.03). All other parameters were not statistically different between the groups. CONCLUSIONS: Emergency departments practicing follow-up calls by non-health care providers should consider a forecasted increase in return rates.

Personal experience in pediatric emergency medicine training in Canada and China.

Currently, pediatric emergency medicine (PEM) as practiced in many developed countries is different from ours in China. Chinese pediatric emergency medicine is just children's internal medicine and does not include general surgery, ear-nose-throat, etc. If children have an emergency condition that require specialized treatments they need to go to different departments. However in Canada, the pediatric emergency physicians will first treat the patients whatever the condition, then, if it is a complicated sub specialty problem, they will consult the specialist or let the patient see the specialist later. In addition, resuscitation is done in the pediatric intensive care unit (PICU) in China, but it is done in the emergency room in Canada. This article compares the differences in the pediatric emergency systems in Canada and China and also introduces the international standard system of pediatric triage.