Pediatric emergency department crowding during multiple resuscitation events.

BACKGROUND

Multiple, simultaneous resuscitations in pediatric emergency departments (PEDs) strain resources and exacerbate crowding. In 2015, our pediatric institution implemented a Multiple Resuscitation Activation (MRA) to coordinate team response. The impact of MRAs on PED crowding remains unclear.

OBJECTIVES

Evaluate whether MRAs are associated with changes in PED crowding and patient census.

METHODS

A retrospective cohort study was conducted at a tertiary pediatric level one trauma center from January 2023 to December 2024. MRA events were matched 1:2 with non-activation control periods by time of day and calendar proximity. Crowding was measured using the Pediatric Emergency Department Overcrowding Scale (PEDOCS) at baseline and at 1 and 2 h after activation (or matched control time). Difference-in-differences analyses were used to compare changes in PEDOCS and patient census between activation and control periods.

RESULTS

Thirteen MRAs involving 59 patients were identified, with a median activation duration of 73 min. Although PEDOCS scores and patient census increased following MRAs, these changes were not significantly different from those in matched control periods. The difference-in-differences estimate for PEDOCS was 6.0 points (95% CI, -15.4 to 27.4) at 1 h and 7.8 points (95% CI, -13.6 to 29.2) at 2 h. Corresponding estimates for patient census were 2 patients (95% CI, -17 to 21) and 6 patients (95% CI, -16 to 28).

CONCLUSIONS

MRAs were not associated with significant increases in PED crowding or patient census compared with matched non-activation control periods. These findings suggest that coordinated response systems may help mitigate the operational impact of multiple simultaneous resuscitations.