Unscheduled return visits to a pediatric emergency department

Kairienė, Ignė; Strička, Marius; Labanauskas, Liutauras; Čerkauskienė, Rimantė; Raistenskis, Juozas; Burokaitė, Emilija; Usonis, Vytautas

doi:10.1016/j.medici.2017.01.003

Cited by 11 publications

(13 citation statements)

References 18 publications

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“…We reviewed and analyzed both their demographic characteristics and clinical outcomes and compared them with those admitted to the ICU on initial visits. A previous nationwide-based study in the U.S. from 2012 showed that 698,000 pediatric ED revisits (2.7%) were documented over 7 years [17, 18]. In that study, among all PED revisit patients, the ICU admission rate was about 16.7 per 100,000 PED discharges.…”

Section: Discussionmentioning

confidence: 89%

ICU admission following an unscheduled return visit to the pediatric emergency department within 72 hours

et al. 2019

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Introduction The purpose of this study was to describe the demographic characteristics and prognosis of children admitted to the intensive care unit (ICU) after a pediatric emergency department (PED) return visit within 72 h. Method We conducted this retrospective study from 2010 to 2016 in the PED of a tertiary medical center in Taiwan and included patients under the age of 18 years old admitted to the ICU after a PED return visit within 72 h. Clinical characteristics were collected to perform demographic analysis. Pediatric patients who were admitted to the ICU on an initial visit were also enrolled as a comparison group for outcome analysis, including mortality, ventilator use, and length of hospital stay. Results We included a total of 136 patients in this study. Their mean age was 3.3 years old, 65.4% were male, and 36.0% had Chronic Health Condition (CHC). Disease-related return (73.5%) was by far the most common reason for return. Compared to those admitted on an initial PED visit, clinical characteristics, including vital signs at triage and laboratory tests on return visit with ICU admission, demonstrated no significant differences. Regarding prognosis, ICU admission on return visit has a higher likelihood of ventilator use (aOR:2.117, 95%CI 1.021~4.387), but was not associated with increased mortality (aOR:0.658, 95%CI 0.150~2.882) or LOHS (OR:-1.853, 95%CI -4.045~0.339). Conclusion Patients who were admitted to the ICU on return PED visits were associated with an increased risk of ventilator use but not mortality or LOHS compared to those admitted on an initial visit.

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Section: Discussionmentioning

confidence: 89%

ICU admission following an unscheduled return visit to the pediatric emergency department within 72 hours

et al. 2019

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“…To minimize the likelihood of capturing revisits unrelated to the initial visit complaint, a 72 h window for revisit was used. 29,31,33,34,38,44 All patients with at least one revisit to the ED within 72 h of discharge from their index visit were categorized as having a revisit. If patients had more than one revisit within the 72 h period after an index visit, we only considered the first revisit in the analysis.…”

Section: Primary Outcomesmentioning

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%

Association of limited English proficiency and increased pediatric emergency department revisits

Portillo

Stack

Monuteaux

et al. 2021

Academic Emergency Medicine

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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.

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“…Overall, our observed frequency of ED return visits was low, and we found no statistically significant difference between the two study groups (2.8% among pathway adherent versus 0.9% among pathway deviant, P=0.14). Previously reported general RTED rates ranges from 3 to 8.7% (15)(16)(17)(18)(19) and 4.1% in an asthma specific population (20). The discrepancy between our findings and prior studies may be related to the time frame applied to the returns: most studies report returns within 48 hours to 7 days as opposed to the 24 hours time frame used in our study.…”

Section: Discussionmentioning

confidence: 99%

Use of a standardized asthma severity score to determine emergency department disposition for paediatric asthma: A cohort study

Judge

Tabeshi

Yao

et al. 2018

Paediatrics &Amp; Child Health

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Background:We recently introduced a clinical practice pathway for the management of asthma that uses the Pediatric Respiratory Assessment Measure (PRAM) to guide emergency department (ED) treatment and disposition. The pathway recommends discharge for patients who achieve improvement to PRAM <4 at 1 hour after the last bronchodilator. We evaluated practice variation and patient outcomes associated with PRAM-directed disposition recommendations. Methods: We conducted a retrospective cohort study of children aged 2 to 17 years treated for moderate asthma (PRAM score 4-7) using our asthma clinical pathway. We measured 1) the proportion of children discharged per pathway criteria who returned to our ED within 24 hours and 2) the proportion of children observed beyond the pathway discharge criteria who deteriorated (PRAM ≥4). Results: We analyzed 385 patient records from September 2013 to February 2015. Among 145 (37.7%) patients discharged per pathway criteria, 4 (4/145; 2.8%) returned within 24 hours. The remaining 240 (62.2%) were observed beyond the pathway discharge criteria; 76/240 (31.7%) had a subsequent deterioration (PRAM score ≥ 4) and 25/240 (10.4%) were hospitalized. Of those who deteriorated, 46/76 (60.5%) worsened within the first additional hour of observation. Conclusion:We observed significant deviation from our PRAM-directed pathway discharge criteria and that a significant proportion of observed patients experienced clinical deterioration beyond the first hour of observation. We recommend observing children with moderate asthma for 2 or 3 hours from last bronchodilator therapy if PRAM < 4 is maintained, to capture the majority (97.7% or 99.7%) of patients who require further intervention and hospitalization.

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Unscheduled return visits to a pediatric emergency department

Abstract: RVs accounted for only a small proportion of visits to the ED. RVs were more prevalent among younger patients and patients with a GP referral as well as performed more often after discharging from the ED in the evening and at night.

Cited by 11 publications

References 18 publications

ICU admission following an unscheduled return visit to the pediatric emergency department within 72 hours

ICU admission following an unscheduled return visit to the pediatric emergency department within 72 hours

Association of limited English proficiency and increased pediatric emergency department revisits

Use of a standardized asthma severity score to determine emergency department disposition for paediatric asthma: A cohort study

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