Despite the increase in research activity and funding since 1993, the questions about pediatric emergency care posed in the 1993 IOM report remain not only salient, but also largely unanswered.
What is the structure of the system? There is no central resource containing reliable information on the number and characteristics of the facilities, emergency care providers, and services available in the emergency care system. However, different organizations that represent emergency providers collect some basic information. For example, the American Hospital Association keeps a tally of the total number of EDs in the country, and the National Association of Children’s Hospitals and Related Institutions keeps a list of the number of children’s hospitals. Additionally, we have a general idea from surveys of the percentage of EMS agencies that are fire department–based versus stand-alone. However, this information is only the first step in understanding the structure of the emergency care system. Information on the capabilities and services available from each provider remains elusive, as does information on how the structure varies within and across states and regions.
Who uses the system?, For what is the system used?, What services or procedures are provided to patients?, and When are services provided? We are able to answer all of these questions today with regard to children’s use of EDs; however, these questions remain unanswered with respect to those using the prehospital (EMS) system. One important source of information on ED utilization is the federal National Hospital Ambulatory Medical Care Survey (NHAMCS), which has collected nationally representative information on ED visits since 1992. NHAMCS allows researchers to study the use of EDs by patient characteristics including age, race, and insurance status. The data also include the reason for the visit and the triage category (for example, immediate, urgent, nonurgent); the physician’s diagnosis for each patient, as well as the diagnostic, screening, surgical, counseling, educational, and therapy services provided during the visit; and when patients arrived at the ED, how long they waited, and when they left.
Another important data source is the State Emergency Department Databases (SEDD), part of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ). The SEDD captures information on all ED visits that do not require admission and allows for the analysis of data at the state or, in many cases, the county level. The SEDD contains more than 100 clinical and nonclinical variables, including diagnoses, procedures, patient demographics, expected payer source, charges, hospital identifiers, and county identifiers. As of September 2005, 17 states were participating, and data from many of those states are available for the years 1999 to 2004 (AHRQ, 2005).
In contrast to these in-hospital data systems, data collection on the