Assistant Professor Queen's University Kingston, Ontario, Canada
Background: There has been a recent increase in emergency department (ED) volumes across the developed world, including for children. Increased ED wait times and overcrowding are known to increase mortality and threaten patient safety. It is unclear what demographic and/or patient-related factors are driving these changes. How these factors have altered the pediatric emergency care demands is poorly understood. Canadian healthcare facilities are required to provide standard data reports for outpatient care through the National Ambulatory Care Reporting System (NACRS). We hypothesized that patient factors have shifted over time driving the recent increased pediatric urgent care service demand. Objective: We aimed to use the high fidelity NACRS urgent care patient data to model the factors that have led to the increased demand at our local pediatric urgent care centre. Design/Methods: The dataset was obtained from our local healthcare centre’s NACRS reporting data from April 1, 2006 to Dec 31, 2022. This dataset consisted of 180,408 unique visits to our academic centre’s pediatric urgent care. Results: Over the study period, there was an overall substantial increase in the number of visits per day, with a rapid increase beyond previous levels in 2021 and further in 2022. The total hours of care in 2022 were 1.8 times the mean value of the all the previous years where there is complete data (2007-2021). The increased length of stay trend was consistent across the four most common presenting complaint categories (infectious, respiratory, musculoskeletal, and other). The increase in patients without primary care from 2021 to 2022 was from 9.1% to 13.0%. The proportion of patients without primary care in 2022 was 2.5 times higher than in 2013. A random forest machine learning model revealed features more likely to be associated with a 2022 visit compared to other years. In decreasing level of relative importance to the model were: longer stay, later registration in the day, diagnosis of an infectious illness, and younger age.
Conclusion(s): Our study identified a combination of declining primary care access, circulating viral infections, and more urgent complex presentations as factors driving the recent increase in frequency and duration of visits to our urgent care service. Understanding the evolving changes to patient factors that are influencing urgent care service needs can inform proactive resource allocation and improve outcomes.
