A New After-Hours Clinic Model Provides Cost-Saving, Faster Care Compared With a Pediatric Emergency Department

Sterner, Sarah; Coco, Teresa; Monroe, Kathy; King, William D.; Losek, Joseph D.

doi:10.1097/pec.0b013e318271733e

Cited by 7 publications

(3 citation statements)

References 13 publications

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“…9 Recently, a national parent survey demonstrated that among enhanced access services including same-day sick visits, phone advice outside office hours, and e-mail advice, only extended primary care office hours (after 5 pm on 5 or more nights a week) was associated with decreased ED use. 5 Sterner et al 10 recently reported a cost saving of an AH pediatric clinic versus a pediatric ED. In their model, patients were triaged by a phone nurse and referred to the ED or AH clinic by appointment only.…”

Section: Discussionmentioning

confidence: 99%

After-Hours Pediatric Care Compared With Emergency Department Care

Goodrich

Evans

Gress

et al. 2015

Clin Pediatr (Phila)

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Section: Discussionmentioning

confidence: 99%

After-Hours Pediatric Care Compared With Emergency Department Care

Goodrich

Evans

Gress

et al. 2015

Clin Pediatr (Phila)

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“…We identified four common themes across these interventions and grouped them under these following themes: (1) improving timely access to primary care, (2) integrating hospital and GP care, (3) providing financial support and (4) implementing new clinics/ services (online supplemental appendix table 6). Some examples of the 'outside ED' interventions or strategies were: increasing after-hours primary care, 37 free access to primary care for the uninsured, 38 adjacent or co-located primary care clinic for lower acuity patients, 39 introduction of a patient-centred medical home that addresses primary care needs of patients, 40 implementation of GP cooperatives (out-of-hours primary healthcare in one centrally located practice), 41 urgent care collaborations between the GP and ED, 42 GP-led walk-in centres, 43 PCP blended fee for service, 44 hospital-integrated general practice for emergency care services, 45 integrated emergency posts where care is provided by both ED and GPs, 46 rural health clinics 47 and advanced access primary care with timely access. 48 Involvement of primary healthcare providers The type of PHCP involved in the interventions or strategies involving PHCPs were as follows: family physician (n=85, 31.7%), NP (n=69, 25.7%) or nurse given increased authority (n=43, 16%).…”

Section: Interventions and Strategies Involving Phcpsmentioning

confidence: 99%

Interventions and strategies involving primary healthcare professionals to manage emergency department overcrowding: a scoping review

et al. 2021

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ObjectivesTo conduct a scoping review to identify and summarise the existing literature on interventions involving primary healthcare professionals to manage emergency department (ED) overcrowding.DesignA scoping review.Data sourcesA comprehensive database search of Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley) and CINAHL (EBSCO) databases was conducted (inception until January 2020) using peer-reviewed search strategies, complemented by a search of grey literature sources.Eligibility criteriaInterventions and strategies involving primary healthcare professionals (PHCPs: general practitioners (GPs), nurse practitioners (NPs) or nurses with expanded role) to manage ED overcrowding.MethodsWe engaged and collaborated, with 13 patient partners during the design and conduct stages of this review. We conducted this review using the JBI guidelines. Two reviewers independently selected studies and extracted data. We conducted descriptive analysis of the included studies (frequencies and percentages).ResultsFrom 23 947 records identified, we included 268 studies published between 1981 and 2020. The majority (58%) of studies were conducted in North America and were predominantly cohort studies (42%). The reported interventions were either ‘within ED’ (48%) interventions (eg, PHCP-led ED triage or fast track) or ‘outside ED’ interventions (52%) (eg, after-hours GP clinic and GP cooperatives). PHCPs involved in the interventions were: GP (32%), NP (26%), nurses with expanded role (16%) and combinations of the PHCPs (42%). The ‘within ED’ and ‘outside ED’ interventions reported outcomes on patient flow and ED utilisation, respectively.ConclusionsWe identified many interventions involving PHCPs that predominantly reported a positive impact on ED utilisation/patient flow metrics. Future research needs to focus on conducting well-designed randomized controlled trials (RCTs) and systematic reviews to evaluate the effectiveness of specific interventions involving PHCPs to critically appraise and summarise evidence on this topic.

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“…Younger age was found to be a risk factor in driving the nonurgent ED use in this review 9 . From a cost-benefit analysis, median costs related to treatment for common diagnoses in an ED can be 4 to 5 times higher in comparison with similar care provided for the same conditions in a pediatric clinic 10,11 …”

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confidence: 99%

Do Unmet Health Needs Drive Pediatric Emergency Department Utilization?

et al. 2020

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Lack of access to basic health services is thought to increase emergency department (ED) utilization. This study assessed the relationship between unmet health care needs and pediatric ED utilization in the United States. Methods:The National Survey of Children's Health was used (2016-2017; n = 71,360). Parent/guardians reported number of ED visits and the presence of unmet health needs (medical, dental, mental health, vision, hearing, other) in the last 12 months. Associations were analyzed using multinomial logistic regression modeling and accounted for the weighting and complex survey design of the National Survey of Children's Health. Results:Children with 2 or more unmet health needs had 3.72 times (95% confidence interval, 2.25-6.16) risk of ≥2 ED visits when compared with those with 0 unmet health needs. This risk became nonsignificant when adjusted for race, ethnicity, age, insurance, having asthma, current medication status, health description, number of preventative health visits, and place to go for preventative health (aRR, 1.77; 95% confidence interval, 0.96-3.27). The adjusted association was also nonsignificant for specific types of unmet needs. Race, insurance status, age 0 to 3 years, current medication status, having asthma, ≥2 preventative visits, and poorer health were associated with ≥2 ED visits.Conclusions: Unmet health needs were not found to be a significant driving force for ED utilization. Other factors were found to be more strongly associated with it. Future studies to understand the perception, motives, and complex interaction of various factors leading to ED use in high-risk populations may optimize care for these children.

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A New After-Hours Clinic Model Provides Cost-Saving, Faster Care Compared With a Pediatric Emergency Department

Abstract: Our AHC model showed a significant reduction in length of stay and charges in compared demographically and clinically matched PED patients. This may be an effective model to help address emergency department overcrowding and promote patient safety.

Cited by 7 publications

References 13 publications

After-Hours Pediatric Care Compared With Emergency Department Care

After-Hours Pediatric Care Compared With Emergency Department Care

Interventions and strategies involving primary healthcare professionals to manage emergency department overcrowding: a scoping review

Do Unmet Health Needs Drive Pediatric Emergency Department Utilization?

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