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Introduction: Radiofrequency identification (RFID) technology has been used in other emergency department settings but has not been assessed in a pediatric emergency department setting for its reliability in its application as a patient tracking system. The goal of this study was to assess the accuracy, precision, and reliability of the technology in a simulated pediatric emergency department setting to collect patient tracking information., Methods: A simulated pediatric emergency department clinical assessment room was developed to serve as a test room to collect patient tracking information. This information included the interaction times between simulated patients, parents, physicians, and nurses. Direct observation of these interaction times were recorded by an observer. A patient tracking system based on active RFID technology recorded interaction times between models wearing RFID devices and recorded this information in a computerized data log. Comparison between the direct observation record and the data log was used to determine accuracy, precision, and reliability., Results: A total of 152 directly observed interactions were recorded. Data extraction from the data log yielded 152 sensor-recorded interactions, resulting in a reliability of 1.0. Data pair comparison on all events resulted in a mean difference of 2.88 seconds., Conclusions: Active RFID-based patient tracking systems are a precise and reliable means of recording patient interaction events in the pediatric emergency department.

Background: Patient safety is of great importance in the pediatric emergency department (PED). The combination of acutely and critically ill patients and high patient volumes creates a need for systems to support physicians in making accurate and timely diagnoses. Electronic patient tracking systems can potentially improve PED safety by reducing overcrowding and enhancing security., Objectives: To enhance our understanding of current electronic tracking technologies, how they are implemented in a clinical setting, and resulting effect on patient care outcomes including patient safety., Methods: Nine databases were searched. Two independent reviewers identified articles that contained reference to patient tracking technologies in pediatrics or emergency medicine. Quantitative studies were assessed independently for methodological strength by two reviewers using an external assessment tool., Results: Of 2292 initial articles, 22 were deemed relevant. Seventeen were qualitative, and the remaining five quantitative articles were assessed as being methodologically weak. Existing patient tracking systems in the ED included: infant monitoring/abduction prevention; barcode identification; radiofrequency identification (RFID)- or infrared (IR)-based patient tracking. Twenty articles supported the use of tracking technology to enhance patient safety or improve efficiency. One article failed to support the use of IR patient sensors due to study design flaws., Conclusions: Support exists for the use of barcode-, IR-, and RFID-based patient tracking systems to improve ED patient safety and efficiency. A lack of methodologically strong studies indicates a need for further evidence-based support for the implementation of patient tracking technology in a clinical or research setting., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Quality assurance is a new and important area of research in pediatric emergency medicine (PEM). There are few studies that describe which performance indicators best represent the PEM practice. The primary study objective is to construct a set of performance indicators that have been selected by current and former pediatric emergency department (PED) medical directors as most useful in assessing PED performance. The secondary objective is to assess which indicators are currently measured to assess performance in PEDs., Methods: Current and former directors of accredited Canadian PEM programs were considered as eligible participants. A list of indicators was generated by a survey (item pool generation); this list was refined by clarifying unclear terms or eliminating redundant and unquantifiable performance indicators (item scaling); PED directors were asked to rate each item of this refined list to indicate which indicators were more useful in assessing PED performance (item prioritization). A novel ranking formula was used to prioritize those items considered most useful by a larger proportion of respondents, using the provided rating scores., Results: Fourteen current and former medical directors were considered eligible participants. Indicators related to patient morbidity and mortality, adverse outcomes, return visits, patient length of stay (LOS), and waiting times were considered to be more useful. Less useful indicators included the number of deaths, daily census, number of incident reports, and individual physicians' admission rates. The most commonly measured PED performance indicators included the rate of patients who left without being seen, patient LOS, and the waiting time until being seen by a physician by triage category., Conclusions: The top quartile of performance indicators considered most useful by participants included indicators that reflected clinical outcomes, LOS, and waiting times. A dichotomy may exist between those performance indicators that PED directors considered more useful and those indicators that are currently measured.

Unlabelled: Increasing patient census and department overcrowding are universal concerns in pediatric emergency medicine. Accurate predictions of patient flow and resource utilization in the pediatric emergency department (PED) are important in determining what aspects of PED activity could be modified to improve patient flow, reduce patient waiting times, and increase staff efficiency and morale, and thus direct change more effectively., Background: We report (1) the construction of a Patient Flow Model (PFM) using discrete event simulation to test simulated PED staffing scenarios that were designed to alleviate the pressures that result from increased census and overcrowding, and (2) a Physician Scheduling Analysis Tool to assist in physician scheduling., Methods: Arena discrete event simulation modeling software was used to develop a model of PED patient flow after extensive interviews with PED staff and direct observation of patient flow in July 2005. A total of 517 patients were directly observed, and all modeled aspects of their interaction with PED staff and resources were recorded. Historical demographic patient arrival information was combined with observed patient flow data to provide simulated patient arrival rates for the PFM and was also used to construct the Physician Scheduling Analysis Tool. Validation of the PFM was performed by comparing annual simulated patient flow data with actual patient flow data. Previously determined staffing scenarios were applied to the simulation and the resulting performance indicator outputs examined., Results: The PFM was validated on model-wide and process-specific levels, with excellent validation observed on high acuity-patient length of stay and for highly detailed processes such as triage and registration. Simulation of the addition of a hospital volunteer and a second triage nurse demonstrated reductions in pretriage waiting time and the proportion of patients waiting longer than 30 or 60 minutes for pretriage. Simulation of an extra physician shift to the staff schedule demonstrated reductions in length of stay for patients of all triage categories., Conclusions: The PFM accurately represents patient flow through the department and can provide simulated patient flow information on a variety of scenarios. It can effectively simulate changes to the model and its effects on patient flow.