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Variability in the emergency department use of discretionary radiographs in children with common respiratory conditions: the mixed effect of access to pediatrician care

Published online by Cambridge University Press:  04 March 2015

Astrid Guttmann ,
Michael Weinstein ,
Peter C. Austin ,
Azim Bhamani  and
Geoffrey Anderson
Astrid Guttmann*
Affiliation:
Division of Paediatric Medicine, The Hospital for Sick Children Department of Paediatrics, Faculty of Medicine, University of Toronto Institute for Clinical Evaluative Sciences Department of Health Policy, Management and Evaluation, University of Toronto
Michael Weinstein
Affiliation:
Division of Paediatric Medicine, The Hospital for Sick Children Department of Paediatrics, Faculty of Medicine, University of Toronto
Peter C. Austin
Affiliation:
Division of Paediatric Medicine, The Hospital for Sick Children Department of Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, University of Toronto, Toronto, ON
Azim Bhamani
Affiliation:
Division of Paediatric Medicine, The Hospital for Sick Children
Geoffrey Anderson
Affiliation:
Division of Paediatric Medicine, The Hospital for Sick Children Department of Health Policy, Management and Evaluation, University of Toronto
*
Institute for Clinical Evaluative Sciences, G Wing, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5; astrid.guttmann@ices.on.ca

Abstract

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Objectives:

The objective of this study was to investigate whether different staffing models are associated with variation in radiograph use for children seen for bronchiolitis, croup, and asthma and discharged home from emergency departments (EDs) in Ontario.

Methods:

We surveyed all Ontario EDs regarding physician staffing models and use of clinical protocols. We used a population-based ED database to determine radiograph rates and patient characteristics. Regression techniques that controlled for patient factors and clustering within EDs were applied.

Results:

From April 2004 to March 2006, 5,186, 10,408, and 35,150 children were discharged home from an ED with bronchiolitis, croup, and asthma, respectively. Radiograph rates were 42.7% for bronchiolitis, 10.1% for croup, and 25.9% for asthma. Over 50% of children were treated in EDs with nonpediatric front-line care but with consultant pediatricians available. Compared to children in these settings, those seen in EDs with front-line pediatric staff were less likely to have radiographs for all three conditions (adjusted odds ratios [ORs] 0.47 [95% CI 0.24–0.95], 0.47 [95% CI 0.27–0.82], 0.13 [95% CI 0.02–0.66] for bronchiolitis, croup, and asthma, respectively). Children in community hospitals with pediatricians were significantly more likely to have a radiograph if seen by a consultant pediatrician (OR 1.40, 95% CI 1.20–1.63 [bronchiolitis]; OR 2.76, 95% CI 2.16–3.53 [croup]; and OR 1.97, 95% CI 1.64–2.36 [asthma]). We found no association between clinical protocol use and radiograph rates.

Conclusions:

High rates of discretionary radiograph use exist for common respiratory problems of children seen across ED settings. Quality improvement efforts should be focused in this area, and radiograph use in EDs staffed by front-line pediatrics-trained staff could serve as an initial benchmark target for other institutions.

Keywords

asthmabronchiolitiscroupemergency carequalityradiography
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 1 , January 2013 , pp. 8 - 17
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

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