The crowding-effectiveness link: it doesn't matter how fast we deliver care if we don't deliver it right.

摘要

In this issue of Annals, Sills et al report on the relationship between the level of crowding in the emergency department (ED) and the quality of care for patients aged 2 to 21 years and treated in a pediatric ED.1 Higher levels of crowding were associated with large increases in the likelihood of delayed care (> 1 hour from triage) for the asthma score and receipt of medications (corticosteroids and beta-agonists). Crowding was also related to lower "effectiveness"; specifically, some patients who should have received corticosteroids and an asthma score did not when their ED reached high levels of congestion. Although it could be argued that because treatment with steroids is a process, not an outcome, it should not be considered a true "effectiveness" measure. However, this study is notably the first to demonstrate that the international epidemic of crowding and its deleterious effects does not spare our youngest patients. It may serve as a clarion call to expose ED flow as a public health problem among advocates of children's health care.