Background: Recent literature regarding the differences in global utilization practices between pediatric emergency medicine fellowship trained providers (PEM) and non-pediatric emergency medicine fellowship trained providers (GEN) is sparse. Our objective was to investigate differences among PEM and GEN ED utilization of laboratory tests, medication orders, and clinical practice among three distinct conditions in pediatric patients.
Methods: A retrospective chart review was conducted in a single academic emergency department for the two years before and after the implementation PEM. Pre-PEM and post-PEM utilization was calculated for laboratory studies and medication orders. 17,203 patients were seen pre-PEM implementation and 26,842 patients were seen post-PEM implementation. Clinical practice differences were considered for three specific conditions. Neonates with fever (N= 38) receiving appropriate LP, CT use with adherence to PECARN criteria in pediatric patients with chief complaint of head injury (N=889), and time to provider evaluation and administration of steroids in pediatric patients diagnosed with asthma exacerbation and admitted to the hospital (N=118) were investigated.
Results: Laboratory utilization per visit decreased from after the implementation of PEM by both PEM and GEN (P<0.0001). Medication use also decreased globally after PEM implementation (P=.04). No differences were detected in appropriate use of LP in febrile neonates. Global CT use in pediatric head trauma was 25.6% pre-PEM versus 27.8% for GEN and 19.0% for PEM in the post-PEM timeframe. PEM adhered to PECARN guidelines more so than GEN or pre-PEM timeframe visits (P<0.0001), but no difference was detected between GEN and pre-PEM timeframe visits. Time to physician in asthma exacerbation was decreased between pre-PEM and post-PEM groups (p=.002 and .007). No difference was detected between the post-PEM groups. Time from physician evaluation to steroid administration decreased significantly from pre-PEM to post-PEM groups (P=0.02 and 0.03). No differences were seen between the post-PEM groups.
Conclusion: Staffing by PEM decreases overall utilization in a pediatric population. Clinical practice of PEM and GEN physicians adheres more closely to the standard of care for several conditions with the addition of PEM. PEM are beneficial to EDs seeing pediatric patients.