Patient and Family Experience in the Pediatric Emergency Department: Association With Real-Time Crowding Monitoring and Operational Factors.

Emergency department (ED) crowding is associated with many types of medical errors and mortality. The association of ED crowding and patient and family experience (PFE) is largely unknown. The study objective was to determine the association between crowding in pediatric EDs (PEDs), operational factors, and PFE scores. This was a retrospective analysis of the association between PED crowding (main exposure as measured by PEDOCS, a validated real-time crowding score) and PFE survey scores (main outcome), for 10,876 patient encounters in two PEDs over 18 months. Multivariable regression was used to determine the association of PEDOCS and relevant covariates with PFE. The PEDs were busy but not overcrowded for 83% of encounters. PED crowding was independently associated with worse PFE. Pairwise comparisons showed PEDOCS-measured crowding was independently associated with worse PFE. The greatest reduction in PFE occurred as the PEDs progressed from "busy" to "extremely busy." Covariates including acuity, arrival time, and patient age were also associated with worse PFE scores. Further work to develop targeted interventions using real-time crowding measures may improve PFE in PEDs.