ED Crowding: The Impact on Child Asthma Care

Previous research has shown that ED crowding is widespread throughout the United States and poses a serious threat to the quality of care that is provided. In studies involving adult patients, increased crowding has been linked to decreased safety, effectiveness, and efficiency of care. Patient-centeredness and timeliness of care are also compromised. While most research on the effect of crowding has been centered on the management of adult patients, few studies have explored the crowding–quality relationship in an ED population of children, largely because of the scarcity of quality measures applicable to children in the ED setting. Acute Asthma at the ED In the March 2011 Annals of Emergency Medicine, Marion R. Sills, MD, MPH, and colleagues examined the crowding-quality association in an ED population of children with acute asthma exacerbations. The cross-sectional study utilized retrospective data on patients aged 2 to 21 who were treated for acute asthma during November 2007 to October 2008 at a children’s hospital ED. “Asthma is among the most common reasons children seek ED care,” says Dr. Sills. “The disease results in 750,000 ED visits annually in the U.S.” “Children seen at a crowded ED for acute asthma were less likely to receive timely and effective care than when the ED is less crowded.” In the study, three processes of care for acute asthma—asthma score, β-agonist, and corticosteroid administration—were reviewed in the context of three quality measures—timeliness, effectiveness, and equity. The measures of timeliness were the percentage of children with acute asthma receiving an asthma score, β-agonist, or steroid within the first hour of arrival to the ED during crowding. Effective care was...