Pediatric Respiratory Score in the Triage Form.

Introduction: Respiratory distress is a common pediatric presentation in emergency departments requiring prompt treatment to avoid poor outcomes. A retrospective chart review at a large community hospital pediatric emergency department revealed that 22% of walk-in patients 0 to 12 years old, who were transferred to a pediatric intensive care unit for a respiratory-related complaint, were undertriaged with an emergency severity index score of 3 or 4. The transferred patients from the hospital's pediatric emergency department with emergency severity index scores of 3 or 4 had an average wait of 1 hour and 15 minutes to see a provider compared with those with an emergency severity index level 1 or 2 who had an average wait of 43 minutes. Implementation of a pediatric respiratory score in emergency department triage formed the basis of a 15-week quality improvement initiative. The aim was to reduce wait times for pediatric patients requiring pediatric intensive care unit care owing to respiratory distress and to decrease door-to-provider and door-to-transfer times.

Methods: Staff were trained over 1 week on respiratory score use. Weekly data were collected on nurse respiratory score utilization for all pediatric respiratory patients, percentage of respiratory patients transferred to a pediatric intensive care unit with the correct emergency severity index level of 1 or 2, and average door-to-provider and door-to-transport times.

Results: A total of 59 patients were transferred for respiratory distress; 86.5% of these were correctly triaged with an emergency severity index level 1 or 2, which was an improvement from 78% the previous year. Average door-to-provider time was 15 minutes for transferred patients with a respiratory score and 20 minutes for those without. Average door-to-transport time was less than 10 hours for both groups.

Discussion: The pediatric respiratory score can improve patient assessment at the point of triage. Since implementing the pediatric respiratory score, wait times have improved for patients transferred to a pediatric intensive care unit with a respiratory complaint.