1
|
Toriola E, Biviano L, Lau C, Hooke N, Donnelly A, Dickins E, Pengilly S, Ging J, Shaw N, Singh J. Advancing Pediatric Care: The virtualKIDS Experience in Nursing-Led Audio-Visual Clinical Services. Creat Nurs 2024; 30:118-124. [PMID: 38600876 DOI: 10.1177/10784535241245667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
During the COVID-19 pandemic, the escalating trend of pediatric patients, particularly non-urgent cases, going to the emergency departments (EDs) in New South Wales, Australia, prompted the establishment of virtualKIDS, a nursing-led telehealth service. This service, initiated in June 2021, operates 24/7 and provides comprehensive care through audio-visual consultations emphasizing a patient-centered approach. Three elements-COVID-19 Outpatient Response Team (CORT), virtualKIDS Acute Review (vKAR), and Virtual Urgent Care (VUC)-addressed specific needs during and beyond the pandemic, showcasing the adaptability and impact of virtual care. vKAR focuses on post-discharge support, allowing families access to telehealth for up to three days. Preliminary data indicates a 44% reduction in ED visits within 48 h. VUC employs nursing-led triaging paired with audiovisual assessment, demonstrating a 69% hospitalization avoidance rate. Hybrid ambulatory models such as a sleep study at home project, day-only tonsillectomies, and arthroscopic knee surgeries showcase innovative approaches to reducing hospital admissions and enhancing patient outcomes. This paper presents the evolution and diverse models of care implemented by the virtualKIDS service, offering insights into its potential as a nursing-led alternative to ED visits in acute-care pediatrics.
Collapse
Affiliation(s)
- Eunice Toriola
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Lyn Biviano
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Christine Lau
- Integrated Care Service, Sydney Children's Hospital Network
| | - Natalie Hooke
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Amie Donnelly
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Emma Dickins
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Sandra Pengilly
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Joanne Ging
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Nadine Shaw
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Jagdev Singh
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
2
|
Ziemnik L, Parker N, Bufi K, Waters K, Almeda J, Stolfi A. Low-Acuity Pediatric Emergency Department Utilization: Caregiver Motivations. Pediatr Emerg Care 2024:00006565-990000000-00421. [PMID: 38534003 DOI: 10.1097/pec.0000000000003195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVES Proper emergency department (ED) utilization is a hallmark of population health. Emergency department overcrowding due to nonurgent visits causes increased stress to healthcare staff, higher costs, and longer wait times for more urgent cases. This study sought to better understand post pandemic reasons caregivers have when bringing in their children for nonurgent visits and devise effective interventions to improve caregiver choice for non-ED care for nonurgent conditions. METHODS Surveys were conducted at an urban pediatric hospital for Emergency Severity Index (ESI) level 3 to 5 visits. A total of 602 surveys were completed with 8 being excluded from analysis. Survey responses and anonymized demographic information were collected. Responses were compared between surveys grouped by respondent age category, relation to child, child's race, insurance type, and ESI levels. RESULTS Primary reasons given for nonurgent ED visits were perceived urgency (74.2%, n = 441), ED superiority to other locations (23.9%, n = 142), and referral to the ED by a third party (17.7%, n = 105). Of those who cited perceived urgency as a reason, 80.5% (n = 355) wanted to lessen their child's pain/discomfort as soon as possible, but only 13.6% said that their child was too ill to be seen anywhere else (n = 60). Demographic differences occurred in the proportions of respondents citing some of the primary and secondary reasons for bringing their child to the ED. CONCLUSIONS This study highlights 3 key findings. An immediate desire for care plays a key role in caregiver decision making for low-acuity visits. There is potential socioeconomic and racial bias in where care is recommended that needs to be further explored in this region. Cross community interventions that target key reasons for seeking low-acuity care have the highest likelihood of impacting the use of the ED for low-acuity conditions.
Collapse
|
3
|
Navion A, Segretin P, Bailhache M. Smartphone App PACOM to Provide Advice Regarding Self-Triage for the Acute Primary Care Needs of Children: Accuracy of Algorithms. Pediatr Emerg Care 2024; 40:27-32. [PMID: 37820384 DOI: 10.1097/pec.0000000000003068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND We developed a phone app, PACOM (Parents Application Conseils et Orientation Médicale), to provide medical advice to caregivers based on several algorithms and a series of binary questions related to children's symptoms. We compared the recommendations of the PACOM algorithms and clinicians for children visiting the emergency department (ED). METHODS Between January and February 2022, we prospectively recruited French-speaking parents of children without any chronic disease who presented to the pediatric ED with any complaint except for mental health problems or trauma. Isolated head trauma was included. They completed questionnaires and the various PACOM algorithms. The first algorithm, called "Quick Look," was developed to identify children with life-threatening emergencies. The standard reference was the advice of the ED clinicians who were blinded to the parental responses to the PACOM algorithm questions. The recommendations included "call urgent medical support," "visit the ED," "visit your general practitioner within 24 hours," and "visit your general practitioner in the next days." RESULTS The study included 269 parents. The response rate was 75%. The median age of the children was 3 years with interquartile range: 1 to 7 years. In total, 268 children completed the "Quick Look," 141 "fever," 83 "abdominal pain," 72 "cough," 70 "vomiting," 130 questionnaires relative to other proposed symptoms, and 70 "other symptom" questionnaires. The PACOM recommendations were "call urgent medical assistant" for 98 children, "ED visit" for 131, "visit general practitioner within 24 hours" for 13, and "visit general practitioner during the next days" for 24. The sensitivity and specificity of the PACOM recommendation to "call urgent medical support or visit the ED" were 98.1% (95% confidence interval, 95.5-100.00) and 22.1% (95% confidence interval, 15.3-28.8), respectively. CONCLUSIONS The PACOM algorithms has high sensitivity but low specificity for reducing ED visits and calls for urgent medical support.
Collapse
Affiliation(s)
- Anouk Navion
- From the CHU de Bordeaux, Pole de pediatrie, Place Amélie Raba Léon, F-33000 Bordeaux, France
| | - Pierre Segretin
- From the CHU de Bordeaux, Pole de pediatrie, Place Amélie Raba Léon, F-33000 Bordeaux, France
| | | |
Collapse
|
4
|
Leung S, McDonald E, Watson A, Doan Q, Desai N. Community healthcare appointments as an alternative to emergency department assessment: an exploration of family acceptability and preferences. CAN J EMERG MED 2023; 25:984-991. [PMID: 37851318 DOI: 10.1007/s43678-023-00605-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Pediatric emergency departments are overcrowded, in part due to many non-emergent visits. We aimed to assess the proportion of parents interested in leaving the pediatric emergency department (ED) prior to physician assessment if they could be offered a scheduled community healthcare appointment. We explored differences in care children received in the ED stratified by interest in a community healthcare appointment and parents' reasons when they were not interested. METHODS We conducted a 14-item survey within the pediatric ED at a Canadian tertiary care teaching hospital to assess parents' interest if a program offered community healthcare appointments and we determined preferred appointment characteristics. All parents presenting with children triaged as CTAS 2-5 who met eligibility criteria were approached by a research assistant prior to physician assessment. Surveys were paired with the medical chart outlining the care received. Descriptive statistics and a regression model were used to describe characteristics of families and care received among those who were and were not interested in a community healthcare appointment. RESULTS In total, 403 surveys were completed. Overall, 236 participants (58.6%; 95% CI 53.8-63.4) were interested in a community healthcare appointment. In general, parents who were interested in a community healthcare appointment were younger and presented with younger children compared to those who were not interested. Among those interested, there was a preference to have the appointment with a pediatrician or family physician, timely access to an appointment, and appointments scheduled outside of regular business hours. CONCLUSION Our study provides evidence that there is interest in an alternative care access model positioned to reduce pediatric ED congestion. We found that parents would be interested in leaving the pediatric ED in favor of a community healthcare appointment, provided it was with a physician and available in a timely manner.
Collapse
Affiliation(s)
- Steve Leung
- Department of Pediatric Emergency Medicine, BC Children's Hospital, Vancouver, BC, Canada
| | - Erica McDonald
- Department of Pediatric Emergency Medicine, BC Children's Hospital, Vancouver, BC, Canada.
| | - Amy Watson
- Department of Pediatric Emergency Medicine, BC Children's Hospital, Vancouver, BC, Canada
| | - Quynh Doan
- Department of Pediatric Emergency Medicine, BC Children's Hospital, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Neil Desai
- Department of Pediatric Emergency Medicine, BC Children's Hospital, Vancouver, BC, Canada
| |
Collapse
|
5
|
Althammer A, Trentzsch H, Prückner S, Gehring C, Hoffmann F. [Pediatric emergency patients in the emergency departments of a German metropolitan region : A retrospective cross-sectional study over a one-year period]. Med Klin Intensivmed Notfmed 2023:10.1007/s00063-023-01064-1. [PMID: 37702784 DOI: 10.1007/s00063-023-01064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/11/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND To date, no detailed analysis of pediatric emergencies treated in emergency departments (ED) exists. However, in the context of capacity planning and upcoming emergency care reform in Germany, these data are urgently needed. METHODS Retrospective, multicenter cross-sectional study for the period 01 July 2013 to 01 June 2014 of pediatric cases in emergency departments in Munich. RESULTS A total of 103,830 cases were analyzed (age: 6.9 ± 5.4 years, boys/girls 55%/45%). A total of 85.9% of cases were treated as outpatients, 12.4% (9.6 per 100,000 children) were admitted to normal and 1.7% (1.0 per 100,000 children) to intensive care. However, the real bed requirements exceeded these guideline numbers, with an absolute requirement of 4.9 ICU beds and 35.1 normal ward beds per day. Load peaks were seen on Wednesday and Friday afternoons and on weekends. Every 8th patient who presented to an ED as a self-referral was treated as an inpatient. CONCLUSION Capacity planning for inpatient emergency care of pediatric patients requires planning for more beds than can be expected on a population basis. The availability of panel physician care influences patient volume in the EDs. Initial medical assessment tools for treatment need and urgency are needed to distribute patients. The pediatric emergency centers planned as part of the current reform of emergency care must be adequately staffed and financed in order to be able to handle-in close cooperation with statutory health insurance-accredited medical care-the expected demand for care.
Collapse
Affiliation(s)
- Alexander Althammer
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der LMU München, Schillerstr. 53, 80336, München, Deutschland
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Heiko Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der LMU München, Schillerstr. 53, 80336, München, Deutschland
| | - Stephan Prückner
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der LMU München, Schillerstr. 53, 80336, München, Deutschland
| | - Christian Gehring
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der LMU München, Schillerstr. 53, 80336, München, Deutschland
| | - Florian Hoffmann
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, LMU Klinikum München, Kinderintensiv- und Notfallmedizin, Lindwurmstr. 4, 80337, München, Deutschland.
| |
Collapse
|
6
|
Simoens E, Michiels L, Toelen J, de Winter P. Navigating the unknown: understanding and managing parental anxiety when a child is ill. Arch Dis Child 2023:archdischild-2022-325220. [PMID: 36927621 DOI: 10.1136/archdischild-2022-325220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Parents are often confronted with a difficult decision when their child falls ill: should they go to the general practitioner (GP) or not? This study aims to describe this process comprehensively in order to allow clinicians to assess the extent to which parents can recognise clinical warning signs and act accordingly. The purpose of this study is to describe parents' decision-making processes when deciding whether or not to consult a GP for their sick child. METHODS We used a qualitative study design based on semistructured interviews to investigate the decision-making process of 25 parents. Four case scenarios describing a developing illness in a child were presented. RESULTS Parents' reasons for seeking medical attention could be divided into two main categories. First, non-specific fears lead parents to consult a doctor. Parents were alarmed by the persistence and progression of symptoms, the combination of symptoms or changes in their child's behaviour or they needed reassurance. Second, several specific fears were identified. Sometimes, parents fear a specific disease, while at other times, they are concerned about warning signs. Some parents, however, would not seek medical attention at any decision point even though their child could be in a potentially life-threatening situation. CONCLUSIONS Although parents make carefully considered decisions on whether or not to consult a doctor, many appear to miss red flags, including more experienced parents. Conversely, some become overly concerned with certain specific symptoms such as fever, and few parents are familiar with self-management strategies.
Collapse
Affiliation(s)
- Elise Simoens
- Department of Pediatrics, KU Leuven University Hospitals, Leuven, Belgium
| | - Lauren Michiels
- Department of Pediatrics, KU Leuven University Hospitals, Leuven, Belgium
| | - Jaan Toelen
- Department of Pediatrics, KU Leuven University Hospitals, Leuven, Belgium.,Leuven Child and Health Institute, KU Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Peter de Winter
- Leuven Child and Health Institute, KU Leuven, Leuven, Belgium .,Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands
| |
Collapse
|
7
|
Malcolm C, King E, France E, Kyle RG, Kumar S, Dick S, Wilson P, Aucott L, Turner SW, Hoddinott P. Short stay hospital admissions for an acutely unwell child: A qualitative study of outcomes that matter to parents and professionals. PLoS One 2022; 17:e0278777. [PMID: 36525432 PMCID: PMC9757586 DOI: 10.1371/journal.pone.0278777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Numbers of urgent short stay admissions (SSAs) of children to UK hospitals are rising rapidly. This paper reports on experiences of SSAs from the perspective of parents accessing urgent care for their acutely unwell child and of health professionals referring, caring for, or admitting children. METHODS A qualitative interview study was conducted by a multi-disciplinary team with patient and public involvement (PPI) to explore contextual factors relating to SSAs and better understand pre-hospital urgent care pathways. Purposive sampling of Health Board areas in Scotland, health professionals with experience of paediatric urgent care pathways and parents with experience of a SSA for their acutely unwell child was undertaken to ensure maximal variation in characteristics such as deprivation, urban-rural and hospital structure. Interviews took place between Dec 2019 and Mar 2021 and thematic framework analysis was applied. RESULTS Twenty-one parents and forty-eight health professionals were interviewed. In the context of an urgent SSA, the themes were centred around shared outcomes of care that matter. The main outcome which was common to both parents and health professionals was the importance of preserving the child's safety. Additional shared outcomes by parents and health professionals were a desire to reduce worries and uncertainty about the illness trajectory, and provide reassurance with sufficient time, space and personnel to undertake a period of skilled observation to assess and manage the acutely unwell child. Parents wanted easy access to urgent care and, preferably, with input from paediatric-trained staff. Healthcare professionals considered that it was important to reduce the number of children admitted to hospital where safe and appropriate to do so. CONCLUSIONS The shared outcomes of care between parents and health professionals emphasises the potential merit of adopting a partnership approach in identifying, developing and testing interventions to improve the acceptability, safety, efficiency, and cost-effectiveness of urgent care pathways between home and hospital.
Collapse
Affiliation(s)
- Cari Malcolm
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
- * E-mail: (PH); (CM)
| | - Emma King
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Emma France
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Richard G. Kyle
- Academy of Nursing, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Simita Kumar
- Screening and Immunisation, Public Health Scotland, Edinburgh, United Kingdom
| | - Smita Dick
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Lorna Aucott
- Centre for Randomised Healthcare Trials, University of Aberdeen, Aberdeen, United Kingdom
| | - Stephen W. Turner
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
- NHS Grampian, Aberdeen, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
- * E-mail: (PH); (CM)
| |
Collapse
|
8
|
Ropers F, Bossuyt P, Maconochie I, Smit FJ, Alves C, Greber-Platzer S, Moll HA, Zachariasse J. Practice variation across five European paediatric emergency departments: a prospective observational study. BMJ Open 2022; 12:e053382. [PMID: 35361639 PMCID: PMC8971764 DOI: 10.1136/bmjopen-2021-053382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare paediatric healthcare practice variation among five European emergency departments (EDs) by analysing variability in decisions about diagnostic testing, treatment and admission. DESIGN AND POPULATION Consecutive paediatric visits in five European EDs in four countries (Austria, Netherlands, Portugal, UK) were prospectively collected during a study period of 9-36 months (2012-2015). PRIMARY OUTCOME MEASURES Practice variation was studied for the following management measures: lab testing, imaging, administration of intravenous medication and patient disposition after assessment at the ED. ANALYSIS Multivariable logistic regression was used to adjust for general patient characteristics and markers of disease severity. To assess whether ED was significantly associated with management, the goodness-of-fit of regression models based on all variables with and without ED as explanatory variable was compared. Management measures were analysed across different categories of presenting complaints. RESULTS Data from 111 922 children were included, with a median age of 4 years (IQR 1.7-9.4). There were large differences in frequencies of Manchester Triage System (MTS) urgency and selected MTS presentational flow charts. ED was a significant covariate for management measures. The variability in management among EDs was fairly consistent across different presenting complaints after adjustment for confounders. Adjusted OR (aOR) for laboratory testing were consistently higher in one hospital while aOR for imaging were consistently higher in another hospital. Iv administration of medication and fluids and admission was significantly more likely in two other hospitals, compared with others, for most presenting complaints. CONCLUSIONS Distinctive hospital-specific patterns in variability of management could be observed in these five paediatric EDs, which were consistent across different groups of clinical presentations. This could indicate fundamental differences in paediatric healthcare practice, influenced by differences in factors such as organisation of primary care, diagnostic facilities and available beds, professional culture and patient expectations.
Collapse
Affiliation(s)
- Fabienne Ropers
- Willem-Alexander Children's Hospital, department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Patrick Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, Amstersdam, Netherlands
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Frank J Smit
- Department of Paediatrics, Maasstad Hospital, Rotterdam, Netherlands
| | - Claudio Alves
- General Paediatrics, Emergency Unit, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Portugal
| | - Susanne Greber-Platzer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Wien, Austria
| | - Henriette A Moll
- Department of General Paediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joany Zachariasse
- Department of General Paediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
9
|
Kozlovski J, Matthews A, Bertenshaw C, Ho JH. Do we do enough paediatrics? Emerg Med Australas 2021; 33:734-736. [PMID: 34196491 DOI: 10.1111/1742-6723.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Jennifer Kozlovski
- Emergency and Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia
| | - Alexander Matthews
- Emergency Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Claire Bertenshaw
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - James H Ho
- Emergency Department, Cabrini Health, Melbourne, Victoria, Australia.,Emergency Department, Austin Health, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Giannouchos TV, Washburn DJ, Gary JC, Foster MJ. Frequent emergency department use in the paediatric population: A systematic literature review. J Eval Clin Pract 2021; 27:193-203. [PMID: 32141125 DOI: 10.1111/jep.13382] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We systematically reviewed the literature on paediatric frequent emergency department (ED) users to identify and to synthesize characteristics and factors associated with frequent ED utilization among this population in the United States. METHODS We searched Medline (Ovid), CINAHL (Ebsco), and Embase (Ovid) to identify all relevant studies after 1990. We focused on US studies analysing paediatric frequent ED (PFED) users excluding those focused on specific subgroups. Two reviewers independently selected articles and extracted data on predisposing, enabling, behavioural, need and reinforcing factors. RESULTS Fifteen studies met the inclusion criteria. PFED users comprised 3% to 14% of all paediatric ED users and accounted for 9% to 42% of all paediatric ED visits in 11 studies that defined frequent use as four to six ED visits per year. Most PFED users were less than 5 years old who had public insurance coverage and a regular provider. Public insurance compared to private residency in disadvantaged areas, having at least one chronic or complex condition and a history of hospitalization, were associated with frequent use. Children who had a regular primary care provider were less likely to exhibit frequent ED use. CONCLUSIONS Minimizing unnecessary ED visits by frequent utilizers is a quality improvement and cost-saving priority for health systems. Our findings indicate that many PFED users have greater healthcare needs and face barriers accessing care in a timely manner, even though some have regular providers. To better address the needs of this vulnerable group, health systems should focus on educating caregivers and expanding access to providers in other settings.
Collapse
Affiliation(s)
- Theodoros V Giannouchos
- School of Public Health, Department of Health Policy and Management, Texas A&M University, College Station, Texas, USA.,Population Informatics Lab, Texas A&M University, College Station, Texas, USA
| | - David J Washburn
- School of Public Health, Department of Health Policy and Management, Texas A&M University, College Station, Texas, USA
| | - Jodie C Gary
- Health Science Center College of Nursing, Texas A&M University, Bryan, Texas, USA
| | - Margaret J Foster
- Medical Sciences Library, Texas A&M University, College Station, Texas, USA
| |
Collapse
|
11
|
Korotchikova I, Al Khalaf S, Sheridan E, O'Brien R, Bradley CP, Deasy C. Paediatric attendances of the emergency department in a major Irish tertiary referral centre before and after expansion of free GP care to children under 6: a retrospective observational study. BMJ Paediatr Open 2021; 5:e000862. [PMID: 33665372 PMCID: PMC7893646 DOI: 10.1136/bmjpo-2020-000862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/06/2021] [Accepted: 01/28/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To examine the characteristics of paediatric attendances to the emergency department (ED) in Cork University Hospital (CUH) before and after the expansion of free general practitioner (GP) care to children under the age of 6 years. DESIGN This is a retrospective observational study that used a large administrative dataset. SETTING The study was conducted in major Irish tertiary referral centre that serves a total population of over 1.1 million. It is a public hospital, owned and managed by the health service executive. PARTICIPANTS Children aged 0-15 years who attended CUH ED during the study period of 6 years (2012-2018) were included in this study (n=76 831). INTERVENTIONS Free GP care was expanded to all children aged 0-5 years in July 2015. MAIN OUTCOME MEASURES Paediatric attendances to CUH ED were examined before (Time Period 1: July 2012-June 2015) and after (Time Period 2: July 2015-June 2018) the expansion of free GP care to children under 6. Changes in GP referral rates and inpatient hospital admissions were investigated. RESULTS Paediatric presentations to CUH ED increased from 35 819 during the Time Period 1 to 41 012 during the Time Period 2 (14.5%). The proportion of the CUH ED attendances through GP referrals by children under 6 increased by over 8% in the Time Period 2 (from 10 148 to 14 028). Although the number of all children who attended CUH ED and were admitted to hospital increased in Time Period 2 (from 8704 to 9320); the proportion of children in the 0-5 years group who attended the CUH ED through GP referral and were subsequently admitted to hospital, decreased by over 3%. CONCLUSION The expansion of free GP care has upstream health service utilisation implications, such as increased attendances at ED, and should be considered and costed by policy-makers.
Collapse
Affiliation(s)
- Irina Korotchikova
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland.,Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - Sukainah Al Khalaf
- School of Public Health, University College Cork, Cork, Munster, Ireland.,INFANT Centre, Cork University Hospital, Cork, Ireland
| | - Ewa Sheridan
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Rory O'Brien
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - Colin P Bradley
- Department of General Practice, School of Medicine, University College Cork, Cork, Ireland
| | - Conor Deasy
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland.,Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| |
Collapse
|
12
|
Chung A, Reeves RM, Nair H, Campbell H. Hospital Admission Trends for Bronchiolitis in Scotland, 2001-2016: A National Retrospective Observational Study. J Infect Dis 2020; 222:S592-S598. [PMID: 32794556 DOI: 10.1093/infdis/jiaa323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bronchiolitis is the commonest cause of respiratory related hospital admissions in young children. This study aimed to describe temporal trends in bronchiolitis admissions for children under 2 years of age in Scotland by patient characteristics, socioeconomic deprivation, and duration of admission. METHODS The national hospital admissions database for Scotland was used to extract data on all bronchiolitis admissions (International Classification of Disease, Tenth Revision, code J21) in children <2 years of age from 2001 to 2016. Deprivation quintiles were classified using the 2011 Scottish Index of Multiple Deprivation. RESULTS Over the 15-year study period, admission rates for children under 2 years old increased 2.20-fold (95% confidence interval [CI], 1.4-3.6-fold) from 17.2 (15.9-18.5) to 37.7 (37.4-38.1) admissions per 1000 children per year. Admissions peaked in infants aged 1 month, and in those born in the 3 months preceding the peak bronchiolitis month-September, October, and November. Admissions from the most-deprived quintile had the highest overall rate of admission, at 40.5 per 1000 children per year (95% CI, 39.5-41.5) compared with the least-deprived quintile, at 23.0 admissions per 1000 children per year (22.1-23.9). The most-deprived quintile had the greatest increase in admissions over time, whereas the least-deprived quintile had the lowest increase. Zero-day admissions, defined as admission and discharge within the same calendar date, increased 5.3-fold (5.1-5.5) over the study period, with the highest increase in patients in the most-deprived quintile. CONCLUSIONS This study provides baseline epidemiological data to aid policy makers in the strategic planning of preventative interventions. With the majority of bronchiolitis caused by respiratory syncytial virus (RSV), and several RSV vaccines and monoclonal antibodies currently in clinical trials, understanding national trends in bronchiolitis admissions is an important proxy for determining potential RSV vaccination strategies.
Collapse
Affiliation(s)
- Alexandria Chung
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh United Kingdom
| | - Rachel M Reeves
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh United Kingdom
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh United Kingdom
| | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh United Kingdom
| | | |
Collapse
|
13
|
Sforzi I, Bressan S, Saffirio C, De Masi S, Bussolin L, Da Dalt L, De Iaco F, Shavit I, Krauss B, Barbi E. The development of a Consensus Conference on Pediatric Procedural Sedation in the Emergency Department in Italy: from here where to? Ital J Pediatr 2020; 46:57. [PMID: 32357893 PMCID: PMC7195721 DOI: 10.1186/s13052-020-0812-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/30/2020] [Indexed: 01/14/2023] Open
Abstract
Background In Italy, as in many European countries, Pediatric Emergency Medicine is not formally recognized as a pediatric subspecialty, hindering nation-wide adoption of standards of care, especially in the field of procedural sedation and analgesia (PSA) in the Emergency Department (ED). For this reason PSA in Italy is mostly neglected or performed very heterogeneously and by different providers, with no reference standard. We aimed to describe the procedures and results of the first multidisciplinary and multi-professional Consensus Conference in Italy on safe and effective pediatric PSA in Italian EDs. Methods The preparation, organization and conduct of the Consensus Conference, held in Florence in 2017, followed the recommended National methodological standards. Professionals from different specialties across the country were invited to participate. Results Overall 86 recommendations covering 8 themes (pre-sedation evaluation, pharmacologic agents, monitoring, equipment and discharge checklists, training, non-pharmacologic techniques, the adult ED setting, impact on hospitalizations) were developed, taking into account the Italian training system and healthcare organization characteristics. Conclusion The results of the first multidisciplinary and multi-professional Consensus Conference in Italy are meant to provide up-to-date national guidance to improve the standard of care of children undergoing painful and stressful procedures in the ED. The recommendations will be periodically updated as new relevant evidence is published.
Collapse
Affiliation(s)
- Idanna Sforzi
- Pediatric Emergency Department and Trauma Center, Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy.
| | - Silvia Bressan
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Claudia Saffirio
- Pediatric Emergency Department and Trauma Center, Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Salvatore De Masi
- Health Sciences Department, University of Florence, Meyer University Children's Hospital, Florence, Italy
| | - Leonardo Bussolin
- Pediatric Emergency Department and Trauma Center, Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Liviana Da Dalt
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Fabio De Iaco
- Emergency Department, Martini Hospital, ASL Città di Torino, Torino, Italy
| | - Itai Shavit
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Baruch Krauss
- Division of Emergency Medicine, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Egidio Barbi
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy.,University of Trieste, Trieste, Italy
| | | |
Collapse
|
14
|
Millar R, Palmer B, Chiappazzo A. Informing diversion strategy: A comparison of parent and general practitioner-referred paediatric patients presenting to a metropolitan hospital. Emerg Med Australas 2020; 32:494-498. [PMID: 32180341 DOI: 10.1111/1742-6723.13499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/08/2020] [Accepted: 02/23/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether the characteristics and outcomes of parent-referred children differ substantially from general practitioner (GP)-referred children attending a metropolitan ED. METHODS Prospective cross-sectional observational study of consecutive patients aged less than 16 years of age attending a mixed adult and paediatric metropolitan teaching hospital ED in Melbourne. Data collected included patient characteristics (age, sex, arrival mode and triage category) and outcomes (admission, specialty consultation, treatment time >1 h, intravenous or nasogastric therapy, procedural sedation, procedures, imaging studies and pathology collection). RESULTS The outcome data of 4580 patients was analysed. Patients brought by parents directly to the ED did not differ from patients referred by their GP in age, sex, or triage category, but were more likely to arrive by ambulance (13% vs 2%, P < 0.01). Low-urgency GP-referred children were more likely to require a procedure (22% vs 15%, risk difference [RD] 0.07, 95% confidence interval [CI] 0.02-0.13) and pathology tests (13% vs 8%, RD 0.05, 95% CI 0.01-0.1) than parent-referred children, but were similar for other outcomes. The proportion of low-urgency children who had no ED-specific care interventions was not significantly different between the groups (27% vs 32%, RD -0.06, 95% CI -0.11 to 0). CONCLUSIONS Children brought to ED directly by their parents or carers did not differ substantially from GP-referred children in their characteristics or outcomes. The use of referral source and triage categories to determine patient suitability for diversion to general practice may need to be reconsidered.
Collapse
Affiliation(s)
- Robert Millar
- The University of Melbourne, Melbourne, Victoria, Australia.,Department of Emergency Medicine, Austin Hospital, Melbourne, Victoria, Australia
| | - Bethany Palmer
- The University of Melbourne, Melbourne, Victoria, Australia
| | | |
Collapse
|
15
|
Ho JH, Dubash R, Kozlovski J. The busyness of medicine. Emerg Med Australas 2019; 31:1101-1103. [PMID: 31769206 DOI: 10.1111/1742-6723.13428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 11/29/2022]
Affiliation(s)
- James H Ho
- Emergency Department, Cabrini Health, Melbourne, Victoria, Australia
| | - Roxanne Dubash
- Emergency Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jennifer Kozlovski
- Emergency and Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|