Patient and Visit Characteristics of Pediatric Patients With High-frequency Low-acuity Emergency Department Visits.
Journal
Pediatric emergency care
ISSN: 1535-1815
Titre abrégé: Pediatr Emerg Care
Pays: United States
ID NLM: 8507560
Informations de publication
Date de publication:
01 Jan 2022
01 Jan 2022
Historique:
pubmed:
5
12
2020
medline:
8
1
2022
entrez:
4
12
2020
Statut:
ppublish
Résumé
Pediatric patients account for a disproportionate number of low-acuity emergency department (ED) visits. The aim of this study is to describe pediatric patient and visit characteristics for high-frequency users for low-acuity visits. This was a retrospective cohort study of children presenting to a tertiary care pediatric ED and an affiliated community ED, over a 2-year period, with at least 10 low-acuity visits. Twenty patients with the highest number of visits were classified as "superusers." We analyzed patient data from the larger sample of high-frequency users and visit specific data from superuser visits. IBM SPSS Statistics 25 (SPSS Inc., Chicago, IL) was used to perform descriptive statistics and to summarize demographic and visit specific variables. We identified 181 high-frequency users with a mean number of visits of 14.3 ± 4.3 and a subpopulation of 20 superusers accounting for 434 visits. The majority of high-frequency users (89%) identified as African American and had public insurance (96.1%). Many patients received primary care affiliated with the home institution. In the first year of the study, 50.3% of high-frequency users were infants younger than 1 year at the index visit and 47.4% of superusers were infants at the index visit.Superuser visits were evenly distributed among seasons and the majority of visits occurred during the weekdays (70.7%). The majority of visits were for medical complaints (86.6%) and almost half (47.6%) resulted in some testing (24.9%) or treatment (30.6%); however, only 1.4% resulted in hospital admission. In our sample, most high-frequency low-acuity ED patients were infants, African American and have public insurance. Many are seen during clinic hours and are paneled at affiliated clinics. Among superusers, the majority of the visits did not require any testing, intervention, or treatment.
Identifiants
pubmed: 33273428
pii: 00006565-202201000-00095
doi: 10.1097/PEC.0000000000002312
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e417-e421Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Disclosure: The authors declare no conflict of interest.
Références
Timm NL, Ho ML, Luria JW. Pediatric emergency department overcrowding and impact on patient flow outcomes. Acad Emerg Med . 2008;15:832–837.
Galarraga JE, Pines JM. Costs of ED episodes of care in the United States. Am J Emerg Med . 2016;34:357–365.
Weinick RM, Bristol SJ, DesRoches CM. Urgent care centers in the U.S.: findings from a national survey. BMC Health Serv Res . 2009;9:79.
McDermott KPD, Stocks CPD, R.N., Freeman WJMPH. https://www.hcup-us.ahrq.gov . https://www.hcup-us.ahrq.gov/reports/statbriefs/sb242-Pediatric-ED-Visits-2015.pdf Web site. Accessed April 6, 2020.
Brousseau DC, Nimmer MR, Yunk NL, et al. Nonurgent emergency-department care: analysis of parent and primary physician perspectives. Pediatrics . 2011;127:e375–e381.
Soril LJ, Leggett LE, Lorenzetti DL, et al. Reducing frequent visits to the emergency department: a systematic review of interventions. PLoS One . 2015;10:e0123660.
Smith V, Mustafa M, Grafstein E, et al. Factors influencing the decision to attend a pediatric emergency department for nonemergent complaints. Pediatr Emerg Care . 2015;31:640–644.
Fieldston ES, Alpern ER, Nadel FM, et al. A qualitative assessment of reasons for nonurgent visits to the emergency department: parent and health professional opinions. Pediatr Emerg Care . 2012;28:220–225.
Davis T, Meyer A, Beste J, et al. Decreasing low acuity pediatric emergency room visits with increased clinic access and improved parent education. J Am Board Fam Med . 2018;31:550–557.
Ladley A, Hieger AW, Arthur J, et al. Educational text messages decreased emergency department utilization among infant caregivers: a randomized trial. Acad Pediatr . 2018;18:636–641.
Racine AD, Alderman EM, Avner JR. Effect of telephone calls from primary care practices on follow-up visits after pediatric emergency department visits: evidence from the Pediatric emergency department links to primary care (PEDLPC) randomized controlled trial. Arch Pediatr Adolesc Med . 2009;163:505–511.
Samuels-Kalow ME, Bryan MW, Shaw KN. Predicting subsequent high-frequency, low-acuity utilization of the pediatric emergency department. Acad Pediatr . 2017;17:256–260.
Neuman MI, Alpern ER, Hall M, et al. Characteristics of recurrent utilization in pediatric emergency departments. Pediatrics . 2014;134:e1025–e1031.
Mirhaghi A, Heydari A, Mazlom R, et al. Reliability of the Emergency Severity Index: meta-analysis. Sultan Qaboos Univ Med J . 2015;15:e71–e77.
Eitel DR, Travers DA, Rosenau AM, et al. The Emergency Severity Index triage algorithm version 2 is reliable and valid. Acad Emerg Med . 2003;10:1070–1080.
Wuerz RC, Milne LW, Eitel DR, et al. Reliability and validity of a new five-level triage instrument. Acad Emerg Med . 2000;7:236–242.
Uscher-Pines L, Pines J, Kellermann A, et al. Emergency department visits for nonurgent conditions: systematic literature review. Am J Manag Care . 2013;19:47–59.
Alpern ER, Clark AE, Alessandrini EA, et al. Recurrent and high-frequency use of the emergency department by pediatric patients. Acad Emerg Med . 2014;21:365–373.
Zandieh SO, Gershel JC, Briggs WM, et al. Revisiting predictors of parental health care-seeking behaviors for nonurgent conditions at one inner-city hospital. Pediatr Emerg Care . 2009;25:238–243.
Kubicek K, Liu D, Beaudin C, et al. A profile of nonurgent emergency department use in an urban pediatric hospital. Pediatr Emerg Care . 2012;28:977–984.
Schlichting LE, Rogers ML, Gjelsvik A, et al. Pediatric emergency department utilization and reliance by insurance coverage in the United States. Acad Emerg Med . 2017;24:1483–1490.
Conners GP, Kressly SJ, Perrin JM, et al. Nonemergency acute care: when it's not the medical home. Pediatrics . 2017;139:e20170629.
Barata I, Brown KM, Fitzmaurice L, et al. Best practices for improving flow and care of pediatric patients in the emergency department. Pediatrics . 2015;135:e273–e283.
Le ST, Hsia RY. Community characteristics associated with where urgent care centers are located: a cross-sectional analysis. BMJ Open . 2016;6:e010663.
Chou SC, Gondi S, Baker O, et al. Analysis of a commercial insurance policy to deny coverage for emergency department visits with nonemergent diagnoses. JAMA Netw Open . 2018;1:e183731.
Long CM, Mehrhoff C, Abdel-Latief E, et al. Factors influencing pediatric emergency department visits for low-acuity conditions. Pediatr Emerg Care . 2018.