Paediatric escalation area and corridor care in the Emergency Department, a secondary analysis of the UNCORKED study

Objective: To describe the use of, and outcomes following, Emergency Department (ED) escalation area care among children. Design: Two-stage prospective multicentre observational study. Stage one was a cross-sectional snapshot study reporting the point prevalence of escalation area care; stage two was an observational cohort study of eligible participants present in the EDs during snapshots. Setting: 5 snapshots of 96 type 1 UK EDs. 83/96 (86.5%) of sites were mixed EDs and 13 sites were paediatric-only EDs. Patients: Patient level data was collected on those who experienced escalation area care and/or were admitted. Outcomes: The primary outcome was the proportion of patients cared for in escalation areas in paediatric-only EDs. Secondary outcomes were demographics, length of stay (LOS), 28-day mortality, type of escalation area experienced and time in escalation areas in all ED types; stratified by escalation area experience. Results: 6.6% (n=75/1132) of patients in paediatric-only EDs were receiving escalation area care during the study snapshots, the majority of this occurred in a minority of departments. Across all ED types, 15.4% (n=104/675) of admitted children experienced escalation area care during their ED stay. 124/244 (50.8%) of those cared for in escalation areas were cared for in a non-clinical area such as a corridor. 9.6% (n=8/83) of mixed EDs reported caring for adults in paediatric areas. Three children died within 28 days; all admitted to hospital without experiencing escalation area care. Hospital LOS was 2.00 days (1.00, 3.00) for those in escalation areas and 2.00 days (2.00, 4.00) for those not cared for in escalation areas. Conclusions: Escalation area care is a common and systemic feature of paediatric emergency care in the UK which requires urgent action to ensure children are cared for in appropriate environments.