Quality of care of children in the emergency department: association with hospital setting and physician training

J Pediatr. 2008 Dec;153(6):783-9. doi: 10.1016/j.jpeds.2008.05.025. Epub 2008 Jul 10.


Objective: To investigate differences in the quality of emergency care for children related to differences in hospital setting, physician training, and demographic factors.

Study design: This was a retrospective cohort study of a consecutive sample of children presenting with high-acuity illnesses or injuries at 4 rural non-children's hospitals (RNCHs) and 1 academic urban children's hospital (UCH). Two of 4 study physicians independently rated quality of care using a validated implicit review instrument. Hierarchical modeling was used to estimate quality of care (scored from 5 to 35) across hospital settings and by physician training.

Results: A total of 304 patients presenting to the RNCHs and the UCH were studied. Quality was lower (difference = -3.23; 95% confidence interval [CI] = -4.48 to -1.98) at the RNCHs compared with the UCH. Pediatric emergency medicine (PEM) physicians provided better care than family medicine (FM) physicians and those in the "other" category (difference = -3.34, 95% CI = -5.40 to -1.27 and -3.12, 95% CI = -5.25 to -0.99, respectively). Quality of care did not differ significantly between PEM and general emergency medicine (GEM) physicians in general, or between GEM and PEM physicians at the UCH; however, GEM physicians at the RNCHs provided care of lesser quality than PEM physicians at the UCH (difference = -2.75; 95% CI = -5.40 to -0.05). Older children received better care.

Conclusions: The quality of care provided to children is associated with age, hospital setting, and physician training.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • California
  • Child
  • Child Health Services / classification*
  • Child Health Services / statistics & numerical data
  • Child, Preschool
  • Educational Status
  • Emergency Service, Hospital / classification*
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Hospitals, Rural*
  • Hospitals, Urban*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Medical Records
  • Models, Statistical*
  • Quality of Health Care / classification*
  • Quality of Health Care / statistics & numerical data
  • Severity of Illness Index
  • United States