The impact of SARS on a tertiary care pediatric emergency department
Identifieur interne : 001438 ( Pmc/Checkpoint ); précédent : 001437; suivant : 001439The impact of SARS on a tertiary care pediatric emergency department
Auteurs : Kathy Boutis ; Derek Stephens ; Kelvin Lam ; Wendy J. Ungar ; Suzanne SchuhSource :
- CMAJ : Canadian Medical Association Journal [ 0820-3946 ] ; 2004.
Abstract
The Greater Toronto Area (GTA) was considered a “hot zone” for severe acute respiratory syndrome (SARS) in 2003. In accordance with mandated city-wide infection control measures, the Hospital for Sick Children (HSC) drastically reduced all services while maintaining a fully operational emergency department. Because of the GTA health service suspensions and the overlap of SARS-like symptoms with many common childhood illnesses, this introduced the potential for a change in the volumes of patients visiting the emergency department of the only regional tertiary care children's hospital.
We compared HSC emergency department patient volumes, admission rates and length of stay in the emergency department in the baseline years of 2000–2002 (non-SARS years) with those in 2003 (SARS year). The data from the prior years were modeled as a time series. Using an interrupted time series analysis, we compared the 2003 data for the periods before, during and after the SARS periods with the modeled data for significant differences in the 3 aforementioned outcomes of interest.
Compared with the 2000–2002 data, we found no differences in visits, admission rates or length of stay in the pre-SARS period in 2003. There were significant decreases in visits and length of stay (
During the SARS outbreak in the GTA, the HSC emergency department experienced significantly reduced volumes of patients with low-acuity complaints. This gives insight into utilization rates of a pediatric emergency department during a time when there was additional perceived risk in using emergency department services and provides a foundation for emergency department preparedness policies for SARS-like public health emergencies.
Url:
DOI: 10.1503/cmaj.1031257
PubMed: 15557588
PubMed Central: 527337
Affiliations:
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<author><name sortKey="Boutis, Kathy" sort="Boutis, Kathy" uniqKey="Boutis K" first="Kathy" last="Boutis">Kathy Boutis</name>
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<author><name sortKey="Stephens, Derek" sort="Stephens, Derek" uniqKey="Stephens D" first="Derek" last="Stephens">Derek Stephens</name>
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<author><name sortKey="Lam, Kelvin" sort="Lam, Kelvin" uniqKey="Lam K" first="Kelvin" last="Lam">Kelvin Lam</name>
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<author><name sortKey="Ungar, Wendy J" sort="Ungar, Wendy J" uniqKey="Ungar W" first="Wendy J." last="Ungar">Wendy J. Ungar</name>
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<author><name sortKey="Schuh, Suzanne" sort="Schuh, Suzanne" uniqKey="Schuh S" first="Suzanne" last="Schuh">Suzanne Schuh</name>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>The Greater Toronto Area (GTA) was considered a “hot zone” for severe acute respiratory syndrome (SARS) in 2003. In accordance with mandated city-wide infection control measures, the Hospital for Sick Children (HSC) drastically reduced all services while maintaining a fully operational emergency department. Because of the GTA health service suspensions and the overlap of SARS-like symptoms with many common childhood illnesses, this introduced the potential for a change in the volumes of patients visiting the emergency department of the only regional tertiary care children's hospital.</p>
</sec>
<sec><title>Methods</title>
<p>We compared HSC emergency department patient volumes, admission rates and length of stay in the emergency department in the baseline years of 2000–2002 (non-SARS years) with those in 2003 (SARS year). The data from the prior years were modeled as a time series. Using an interrupted time series analysis, we compared the 2003 data for the periods before, during and after the SARS periods with the modeled data for significant differences in the 3 aforementioned outcomes of interest.</p>
</sec>
<sec><title>Results</title>
<p>Compared with the 2000–2002 data, we found no differences in visits, admission rates or length of stay in the pre-SARS period in 2003. There were significant decreases in visits and length of stay (<italic>p</italic>
< 0.001) and increases in admission rates (<italic>p</italic>
< 0.001) during the periods in 2003 when there were new and active cases of SARS in the GTA. All 3 outcomes returned to expected estimates coincident with the absence of SARS cases from September to December 2003.</p>
</sec>
<sec><title>Interpretation</title>
<p>During the SARS outbreak in the GTA, the HSC emergency department experienced significantly reduced volumes of patients with low-acuity complaints. This gives insight into utilization rates of a pediatric emergency department during a time when there was additional perceived risk in using emergency department services and provides a foundation for emergency department preparedness policies for SARS-like public health emergencies.</p>
</sec>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">CMAJ</journal-id>
<journal-title>CMAJ : Canadian Medical Association Journal</journal-title>
<issn pub-type="ppub">0820-3946</issn>
<issn pub-type="epub">1488-2329</issn>
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<article-categories><subj-group subj-group-type="heading"><subject>Research</subject>
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<title-group><article-title>The impact of SARS on a tertiary care pediatric emergency department</article-title>
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<contrib-group><contrib contrib-type="author"><name><surname>Boutis</surname>
<given-names>Kathy</given-names>
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<contrib contrib-type="author"><name><surname>Stephens</surname>
<given-names>Derek</given-names>
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<contrib contrib-type="author"><name><surname>Lam</surname>
<given-names>Kelvin</given-names>
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<contrib contrib-type="author"><name><surname>Ungar</surname>
<given-names>Wendy J.</given-names>
</name>
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<contrib contrib-type="author"><name><surname>Schuh</surname>
<given-names>Suzanne</given-names>
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<aff id="N0x2a35920N0x2b82ce8">From the Division of Emergency Medicine (Boutis, Schuh), Population Health Sciences (Stephens, Lam, Ungar) and the Department of Health Policy, Management and Evaluation (Ungar), The Hospital for Sick Children and University of Toronto, Toronto, Ont.<break></break>
</aff>
<pub-date pub-type="ppub"><day>23</day>
<month>11</month>
<year>2004</year>
</pub-date>
<volume>171</volume>
<issue>11</issue>
<fpage>1353</fpage>
<lpage>1358</lpage>
<copyright-statement>© 2004 Canadian Medical Association or its licensors</copyright-statement>
<abstract><sec><title>Background</title>
<p>The Greater Toronto Area (GTA) was considered a “hot zone” for severe acute respiratory syndrome (SARS) in 2003. In accordance with mandated city-wide infection control measures, the Hospital for Sick Children (HSC) drastically reduced all services while maintaining a fully operational emergency department. Because of the GTA health service suspensions and the overlap of SARS-like symptoms with many common childhood illnesses, this introduced the potential for a change in the volumes of patients visiting the emergency department of the only regional tertiary care children's hospital.</p>
</sec>
<sec><title>Methods</title>
<p>We compared HSC emergency department patient volumes, admission rates and length of stay in the emergency department in the baseline years of 2000–2002 (non-SARS years) with those in 2003 (SARS year). The data from the prior years were modeled as a time series. Using an interrupted time series analysis, we compared the 2003 data for the periods before, during and after the SARS periods with the modeled data for significant differences in the 3 aforementioned outcomes of interest.</p>
</sec>
<sec><title>Results</title>
<p>Compared with the 2000–2002 data, we found no differences in visits, admission rates or length of stay in the pre-SARS period in 2003. There were significant decreases in visits and length of stay (<italic>p</italic>
< 0.001) and increases in admission rates (<italic>p</italic>
< 0.001) during the periods in 2003 when there were new and active cases of SARS in the GTA. All 3 outcomes returned to expected estimates coincident with the absence of SARS cases from September to December 2003.</p>
</sec>
<sec><title>Interpretation</title>
<p>During the SARS outbreak in the GTA, the HSC emergency department experienced significantly reduced volumes of patients with low-acuity complaints. This gives insight into utilization rates of a pediatric emergency department during a time when there was additional perceived risk in using emergency department services and provides a foundation for emergency department preparedness policies for SARS-like public health emergencies.</p>
</sec>
</abstract>
</article-meta>
</front>
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<tree><noCountry><name sortKey="Boutis, Kathy" sort="Boutis, Kathy" uniqKey="Boutis K" first="Kathy" last="Boutis">Kathy Boutis</name>
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<name sortKey="Schuh, Suzanne" sort="Schuh, Suzanne" uniqKey="Schuh S" first="Suzanne" last="Schuh">Suzanne Schuh</name>
<name sortKey="Stephens, Derek" sort="Stephens, Derek" uniqKey="Stephens D" first="Derek" last="Stephens">Derek Stephens</name>
<name sortKey="Ungar, Wendy J" sort="Ungar, Wendy J" uniqKey="Ungar W" first="Wendy J." last="Ungar">Wendy J. Ungar</name>
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