Hospital‐Level Factors Associated with Pediatric Emergency Department Return Visits

Pittsenbarger, Zachary E.; Thurm, Cary; Neuman, Mark I.; Spencer, Sandra; Simon, Harold K.; Gosdin, Craig; Shah, Samir S.; McClead, Richard E.; Stack, Anne M.

doi:10.12788/jhm.2768

Cited by 7 publications

(6 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We report similar ED revisit rates as in the pediatric emergency medicine literature. 28,37,38,40,44 Although previous studies have examined predictors for pediatric ED revisits, 27,29,32,[36][37][38]40,[42][43][44] there are limited studies analyzing the impact of language. These focus on revisit to hospitalization and specific diagnoses.…”

Section: Discussionmentioning

confidence: 99%

“…24,25 ED revisits resulting in hospitalization are not necessarily associated with poorer quality care or medical errors [26][27][28] ; however, revisits overall may be associated with crowding, higher medical costs, and lower patient/family satisfaction. 24,[29][30][31][32] Pediatric ED return visits are widely studied, 26,27,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] but few studies examining revisit predictors include language as a factor. 13,14,39 A better understanding of the impact of language on pediatric care quality and outcomes 3 and improved solutions to address these disparities are needed.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association of limited English proficiency and increased pediatric emergency department revisits

Portillo

Stack

Monuteaux

et al. 2021

Academic Emergency Medicine

View full text Add to dashboard Cite

Objective: Limited English proficiency (LEP) is a risk factor for health care inequity and an important focus for improving communication and care quality. This study examines the association between LEP and pediatric emergency department (ED) revisits.Methods: This was a retrospective, cross-sectional study of patients 0 to 21 years old discharged home after an initial visit from an academic, tertiary care pediatric ED from January 1, 2017, to June 30, 2018. We calculated rates of ED revisits within 72 h resulting in discharge or hospitalization and assessed rate differences between LEP and English-proficient (EP) patients. Multivariable logistic regression models examined the association between revisits and LEP status controlling for age, race, ethnicity, triage acuity, clinical complexity, and ED arrival time. Sensitivity models including insurance were also conducted.Results: There were 63,601 index visits in the study period; 12,986 (20%) were by patients with LEP. There were 2,387 (3.8%) revisits within 72 h of initial ED visit. Among LEP and EP patient visits, there were 4.53 and 3.55 revisits/100 initial ED visits, respectively (rate difference = 0.97, 95% confidence interval [CI] = 0.58 to 1.37). In the multivariable analyses, LEP was associated with increased odds of revisits resulting in discharge (odds ratio [OR] = 1.15, 95% CI = 1.01 to 1.30) and in hospitalization (OR = 1.28, 95% CI = 1.03 to 1.58). Sensitivity analyses additionally adjusting for insurance status attenuated these results.Conclusions: These results suggest that LEP was associated with increased pediatric ED revisits. Improved understanding of language barrier effects on clinical care is important for decreasing health care disparities in the ED.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of limited English proficiency and increased pediatric emergency department revisits

Portillo

Stack

Monuteaux

et al. 2021

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…An inverse relationship between socioeconomic status and risk of readmission has been described in other pediatric disease groups as well. [10][11][12] In a study of hospital-level factors associated with return visit rates and return visits with admission, Pittsenbarger et al 13 found that hospitals with the highest rates of these outcomes were more likely to serve populations with lower median household incomes. Proposed factors contributing to this relationship may include lack of access to outpatient follow-up leading to delays in care and therefore presentation with more severe illness.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Readmission Following Febrile Neutropenia in Pediatric Oncology Patients

McCormick

Richardson

Rapkin

et al. 2022

Journal of Pediatric Hematology/Oncology

View full text Add to dashboard Cite

Febrile neutropenia is the most common reason for admission from the emergency department for pediatric oncology patients. We identified pediatric inpatients age 1 to 21 years with an International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code of malignancy and either fever with neutropenia or fever alone over a 6-year period (2007-2012) using the PHIS+ database. We evaluated factors associated with readmission within 7 days after index hospitalization. There were 4029 index hospitalizations among 2349 patients in 6 hospitals, 294 encounters (7.3%) were followed by readmission within 7 days. Factors associated with increased odds of readmission included being in the lowest quartile for median household income (odds ratio [OR] = 1.64, P = 0.009), diagnosis of acute lymphoblastic leukemia (OR = 1.37, P = 0.016), lack of anerobic coverage during index hospitalization (OR = 1.48, P = 0.026), and absolute neutrophil count <200 cells/μL at discharge from index hospitalizations (OR = 1.55, P = 0.008). Patients who required readmission had a longer median length of stay and greater hospitalization costs during the index hospitalization. There was a trend towards increasing hospitalization rates for febrile neutropenia over time. While absolute neutrophil count is incorporated into many risk stratification strategies for fever management, further work should focus on addressing socioeconomic factors which may impact readmission rates.

show abstract

“…This explanation may be further supported by our finding that many postdischarge ED visits are for conditions that are associated with discretionary hospitalization in the ED 27 . A third explanation for this finding may be that poor access to outpatient care outside the hospital setting results in higher postdischarge ED visit rates without increasing the acuity of these revisits or increasing readmission rates 28 ; however, given the validated, risk‐standardized approach to readmission measurement, this is unlikely. This is also unlikely given recent work by Sabbatini et al 23 demonstrating substantial acuity among patients who return to the ED following hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

Association Between Postdischarge Emergency Department Visitation and Readmission Rates

Venkatesh

Wang

et al. 2018

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

Hospital‐Level Factors Associated with Pediatric Emergency Department Return Visits

Abstract: RV rates were associated with population social determinants of health and inversely related to staffing. Hospital-level variation may indicate population-level economic factors outside the control of the hospital and unrelated to quality of care.

Cited by 7 publications

References 37 publications

Association of limited English proficiency and increased pediatric emergency department revisits

Association of limited English proficiency and increased pediatric emergency department revisits

Risk Factors for Readmission Following Febrile Neutropenia in Pediatric Oncology Patients

Association Between Postdischarge Emergency Department Visitation and Readmission Rates

Contact Info

Product

Resources

About