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Predicting Flow in the Pediatric Emergency Department: Are Holidays Lighter?

Krinsky-Diener, Miriam MD*; Agoritsas, Konstantinos MD*; Chao, Jennifer H. MD*; Sinert, Richard DO

doi: 10.1097/PEC.0000000000000714
Original Articles

Objective The aim of this study was to determine whether patient volume in an urban pediatric emergency department (ED) can be predicted based on holidays and thus aid in staffing and resource allocation.

Methods Log-in dates and times were obtained for all patients seen in an urban pediatric ED between July 1, 2006, and June 30, 2013. Visits were coded for the day of the week, tour (ie, shift), and season and whether they occurred on a holiday or nonholiday. Comparisons between the median number of patient visits on holidays versus nonholidays by day of the week, tour, and season were performed. Additional comparisons on 5 Monday holidays as well as New Year's Day, Thanksgiving, and Christmas Day were also performed. Data were presented as medians with interquartile ranges. Group comparisons were performed via using Mann-Whitney U tests and Kruskal-Wallis tests (α = 0.05, 2 tailed).

Results There were 223,677 total patient visits, with a mean yearly census of 31,954. The median daily volume was 85, peaking on Mondays (median, 99). The summer season demonstrated the fewest number of patient visits (median, 74) relative to the other seasons (medians, 89–91). Compared with nonholidays, there were fewer patient visits on Thanksgiving and Christmas Day and in the late afternoon and evening on other individual holidays.

Conclusions Fewer patient visits on Thanksgiving and Christmas Days, as well as during the late afternoon/evening on several other holidays, point to the possibility of small adjustments to staffing in ways that can more efficiently balance demand with available resources.

From the *Pediatric Emergency Department and †Department of Emergency Medicine, Kings County Hospital, SUNY Downstate Medical Center, Brooklyn, NY.

Disclosure: The authors declare no conflict of interest.

Reprints: Miriam Krinsky-Diener, MD, 623 Central Ave, Apt 103, Cedarhurst, NY 11516 (e-mail:

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