Scoping a paediatric emergency medicine unit*

Abstract

Objective

To describe the characteristics and potential patient cohorts suitable for a paediatric emergency medicine unit (PEMU), otherwise known as a short stay unit, at Canberra Hospital, a tertiary mixed adult/paediatric ED treating 98 000 patients annually.

Method

Retrospective descriptive study of paediatric (aged <16) presentations to Canberra Hospital ED between May and August 2022. Patients discharged from ED with a length of stay exceeding 4 h and those admitted non-surgically for less than 2 nights were deemed PEMU suitable; those requiring admission for >2 nights were classed as inpatient ward admission (IWA) patients. Royal children's hospital clinical practice guidelines were used where available to classify the severity of disease via features apparent in ED.

Results

Eight thousand three hundred and forty episodes were identified as paediatric ED presentations, with 1377 (64.8%, 95%CI 62.8–66.9) retrospectively PEMU suitable. This winter sample identified an average of 11.9 potential PEMU suitable cases daily. Chart review showed clinically mild bronchiolitis, mild asthma, anaphylaxis, mild gastroenteritis, afebrile seizure – no known seizure diagnosis, and simple febrile seizures had an excellent profile for PEMU, with subsequent ward admission rates of 17% or less. A mean 7-h stay would require 5 beds with 66% occupancy over 24 h.

Conclusions

Several common paediatric diagnoses are well-suited to a PEMU unit, with reasonable occupancy and length of stay. The low inpatient admission rate suggests less common diagnoses should also be regarded as suitable. Further research is required to identify other paediatric patients and diagnoses suitable for PEMU, and to ratify findings in a whole-of-year sample.