Background: The Academy of Administrators in Academic Emergency Medicine (AAAEM) Benchmarking Survey of academic emergency departments (EDs) in the U.S. was conducted in 2017. Based on survey data, we compared measures of operational performance between Pediatric and Adult (defined as fewer than 5% pediatric visits) EDs.
Methods: We compared measures of1) Patient volumes, length-of-stay (LOS) and acuity and 2) Faculty staffing, productivity and percent effort in academics and administration. T-tests were employed to compare differences in continuous measures and inferences for categorical variables were made using Pearson’s Chi-square test. All p-values were adjusted for multiple comparisons.
Results: Data from17 Pediatric and 52 Adult EDs were available for analysis. We found strong evidence of a difference in the number of annual arrivals between Adult (66,275; IQR 56,184-77,702) and Pediatric EDs (25,416; IQR 19,840-29,349) (p < 0.0001). However, “Arrivals per Faculty Clinical Hour” and “Total Arrivals per Treatment Space” showed no differences (both p=1.00). The percentages of visits 1) arriving by EMS, and 2) for behavioral health were significantly higher in Adult EDs (both p < 0.0001). The mean LOS in hours for “All” patients was significantly longer in Adult (median 5.4; IQR 5.0-6.6) than in Pediatric EDs (3.5; IQR 2.9-4.3) (p = 0.017). A similar difference was found for “Discharged” patients (p=0.004). Emergency Severity Index (ESI) categories, professional E&M codes and hospitalization rates suggest higher acuity in Adult EDs (all p < 0.0001). There was no evidence of a difference in mean work Relative Value Units (RVUs) per patient billed (p=0.46) nor was there evidence of a difference in mean RVUs per faculty clinical hour (p=0.91); the same was true for the aggregate distribution of FTE effort dedicated to academics and administration (p=1.00).
Conclusions: Significant differences in operational measures exist between academic Adult and Pediatric EDs. These have important implications for operational management of the two types of EDs.