Original ArticlesSystem Stresses in 2 Pediatric Emergency Departments and 2 Pediatric Urgent Care Centers During the 2014 Enterovirus-D68 OutbreakConners, Gregory P. MD, MPH, MBA; Doyle, Stacy J. RN, MBA; Fowler, Milton A. Jr MD, MBA; Schroeder, Lisa L. MD; Tryon, Thomas W. MD, MBA Author Information From the Children's Mercy Hospital, Kansas City, MO. Disclosure: The authors declare no conflict of interest. Reprints: Gregory P. Conners, MD, MPH, MBA, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108 (e-mail: [email protected]). Pediatric Emergency Care 34(4):p 250-252, April 2018. | DOI: 10.1097/PEC.0000000000000856 Buy Metrics Abstract Objective To describe the association of an unprecedented large-scale Enterovirus-D68 outbreak in 2014 with changes in patient volume and acuity and system stress in 2 pediatric emergency departments and 2 pediatric urgent care centers of a single children's hospital. Methods We compared measures of patient volume, acuity, and system stress during the 2014 Enterovirus-D68 outbreak and the corresponding dates of the previous year. Results Both settings experienced large census increases during the Enterovirus-D68 outbreak; patient census increased significantly more in the pediatric urgent care setting (20.3%) than in the pediatric emergency departments (14.3%). Both settings had significant increases in patient acuity. The proportion of pediatric emergency department patients requiring hospital admission increased; the proportion of patients who left the pediatric urgent care setting without being seen also increased. Although there was no emergency department inpatient boarding during the 2013 comparison period, 4.4% of admitted patients required emergency department boarding during the 2014 outbreak. There was no significant change in the mean length of stay or the probability that patient admission was to the pediatric intensive care unit. Conclusions Both the pediatric emergency departments and the pediatric urgent care centers experienced increased patient volumes and acuity and significant system stress in association with the 2014 Enterovirus-D68 outbreak. These data will inform those planning resource allocation for future large-scale viral outbreaks. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.