Caretakers' Perspectives on Return Pediatric Emergency Department Visits

Augustine, Erin; Kreling, Barbara; Chamberlain, James M.

doi:10.1097/pec.0000000000000781

Cited by 16 publications

(46 citation statements)

References 15 publications

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“…For example, caregiver's age, marital status and presence/age of other children were not associated with revisits in five studies 33 42–44 55. In contrast, other studies concluded that language spoken at home or single caregivers were associated with revisits 9 12 28 36 40 50 51 64. Next, we found conflicting evidence for the association between lower socioeconomic status and revisits 27 28 30 33 37 40 42 45…”

Section: Resultsmentioning

confidence: 90%

“…Strong evidence was found for the association between revisits and seizures or other nervous system diseases 27 37 39. Lastly, strong association was found between progression/persistence of symptoms and revisits 9 13 36 38 39 44 48 51–56…”

Section: Resultsmentioning

confidence: 95%

“…Strong evidence was found for the association of revisits of children with symptoms of infectious diseases9 29 31 33 35–37 39 43 45 47–50 or respiratory symptoms29 30 35 37 41 45 47–49 51 compared with all ED revisits. Strong evidence was found for the association between revisits and seizures or other nervous system diseases 27 37 39.…”

Section: Resultsmentioning

confidence: 97%

“…There was moderate evidence for the positive influence of a standardised follow-up programme (including, eg, a venue for handling calls after ED visits)8 on patient care and patient satisfaction 8 9. Limited evidence was found that clinical pathways at the ED resulted in a reduced admission rate, shortened length of stay and fewer revisits after discharge 10.…”

Section: Resultsmentioning

confidence: 99%

“…According to four studies,9 12–14 revisits could be reduced by providing consistent verbal and written discharge information regarding the natural history of disease13 and temperature measurement/treatment 14. In contrast, other studies concluded that the provision of safety-net advice did not affect the number of revisits 15 16.…”

Section: Resultsmentioning

confidence: 99%

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Tools for ‘safety netting’ in common paediatric illnesses: a systematic review in emergency care

et al. 2015

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ContextFollow-up strategies after emergency department (ED) discharge, alias safety netting, is often based on the gut feeling of the attending physician.ObjectiveTo systematically identify evaluated safety-netting strategies after ED discharge and to describe determinants of paediatric ED revisits.Data sourcesMEDLINE, Embase, CINAHL, Cochrane central, OvidSP, Web of Science, Google Scholar, PubMed.Study selectionStudies of any design reporting on safety netting/follow-up after ED discharge and/or determinants of ED revisits for the total paediatric population or specifically for children with fever, dyspnoea and/or gastroenteritis. Outcomes included complicated course of disease after initial ED visit (eg, revisits, hospitalisation).Data extractionTwo reviewers independently assessed studies for eligibility and study quality. As meta-analysis was not possible due to heterogeneity of studies, we performed a narrative synthesis of study results. A best-evidence synthesis was used to identify the level of evidence.ResultsWe summarised 58 studies, 36% (21/58) were assessed as having low risk of bias. Limited evidence was observed for different strategies of safety netting, with educational interventions being mostly studied. Young children, a relevant medical history, infectious/respiratory symptoms or seizures and progression/persistence of symptoms were strongly associated with ED revisits. Gender, emergency crowding, physicians’ characteristics and diagnostic tests and/or therapeutic interventions at the index visit were not associated with revisits.ConclusionsWithin the heterogeneous available evidence, we identified a set of strong determinants of revisits that identify high-risk groups in need for safety netting in paediatric emergency care being related to age and clinical symptoms. Gaps remain on intervention studies concerning specific application of a uniform safety-netting strategy and its included time frame.

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Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Tools for ‘safety netting’ in common paediatric illnesses: a systematic review in emergency care

et al. 2015

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Patients who use emergency medical services have greater severity of illness or injury compared to those who present to the emergency department via other means: A retrospective cohort study

Peters,

Goldberg,

Hayes

et al. 2023

JACEP Open

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ObjectiveWe aimed to evaluate the differences in characteristics and illness/injury severity among patients who present to the emergency department (ED) via emergency medical services (EMS) compared to patients who present via other means.MethodsWe analyzed a nationwide sample of ED visits from the 2015–2019 National Hospital Ambulatory Medical Care Survey. We excluded patients <18 or >92 years old, who eloped or left against medical advice, or who arrived via interfacility transport. Mode of presentation was dichotomized to those presenting to the ED via EMS versus any other mode of transportation. Using the appropriate survey sampling weights, we described patient characteristics and compared measures of illness/injury severity between groups using a multivariable logistic regression model.ResultsAn unweighted total of 73,397 ED visits, representing a weighted estimate of 528,083,416 ED visits in the United States during 2015–2019, included 18% arriving via EMS and 82% via other means. EMS patients were older, more often male, more often had multiple chronic medical conditions, and less often had private insurance. EMS patients had higher priority triage scores, consumed more resources in the ED, and had longer lengths of stay. Arrival by EMS was associated with higher odds of hospital admission (odds ratio [OR] 2.7, 95% confidence interval [CI] 2.4–2.9) and in‐hospital mortality (OR 11.1, 95% CI 7.3–17.2).ConclusionsPatients presenting via EMS had significantly different characteristics and outcomes than those presenting via other means. These important differences should be considered when comparing studies of all ED patients versus those who present via EMS.

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The Caregiver Perspective on Unscheduled 72-Hour Return Visits to Pediatric Acute Care Sites: A Focus on Discharge Processes

Navanandan

Schmidt

Cabrera

et al. 2017

Academic Pediatrics

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Caretakers' Perspectives on Return Pediatric Emergency Department Visits

Cited by 16 publications

References 15 publications

Tools for ‘safety netting’ in common paediatric illnesses: a systematic review in emergency care

Tools for ‘safety netting’ in common paediatric illnesses: a systematic review in emergency care

Patients who use emergency medical services have greater severity of illness or injury compared to those who present to the emergency department via other means: A retrospective cohort study

The Caregiver Perspective on Unscheduled 72-Hour Return Visits to Pediatric Acute Care Sites: A Focus on Discharge Processes

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