A Novel Approach Using Relative Value Units to Quantify Workload and Its Association With Patient and Family Experience in the Pediatric Emergency Department

Objectives: To measure the association between overall workload and patient and family experience (PFE) in a pediatric emergency department (ED). Our secondary objective was to assess the construct validity of total ED Relative Value Units (RVUs) as an overall ED workload measure. Methods: We performed a retrospective study from January 2022 to August 2023 using data from a large, urban, academic pediatric ED with approximately 85,000 patient visits annually. PFE was measured by surveys distributed to all patients discharged from ED. The association of overall ED workload with PFE was assessed using multivariate ordinal logistic regression. We examined the construct validity of total ED RVUs by replacing this measure with National Emergency Department Overcrowding Scale (NEDOCS) in the logistic regression model. Results: Of 126,336 discharged visits, 7128 (5.6%) completed surveys. We found a statistically significant association between ED workload and PFE. For each 10 RVUs added to ED workload, the odds of more positive PFE decreased by 9% (95% CI: 8%-9%). The adjusted odds ratio of NEDOCS demonstrated a less pronounced association in the same direction; an increase of 10 points in NEDOCS was associated with 6% (95% CI: 5%-6%) decrease in the likelihood of higher PFE ratings. Conclusions: High ED workload, as measured by overall RVUs, was significantly associated with negative PFE. Similar results were found when we substituted NEDOCS for overall RVUs. Our findings suggest that overall RVUs may be a useful measure of ED workload and might provide a quantitative target for quality improvement.