Characteristics of frequent pediatric emergency department users

Yamamoto, Loren G.; Zimmerman, Kimberly; Butts, Robert J.; Anaya, Carlos; Lee, Peter; Miller, Noreen C.; Shirai, L. K.; Tanaka, Terri T.; Leung, Yam-Kee

doi:10.1097/00006565-199512000-00003

Cited by 57 publications

(51 citation statements)

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“…Our analysis was restricted to adults; as such our findings cannot be generalized to pediatric EMS superusers who are relatively unstudied, but likely have chronic conditions. 37 Additionally, our findings may not reflect more rural EMS systems and populations. The paramedic administrative records used were created for patient care purposes and not for research purposes; therefore, our analysis is limited by the accuracy of the data input by the paramedic arriving on scene.…”

Section: Limitationsmentioning

confidence: 74%

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

Hall¹,

Raven²,

Hall³

et al. 2014

Prehospital Emergency Care

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Objective. Emergency medical services (EMS) "superusers" -those who use EMS services at extremely high rateshave not been well characterized. Recent interest in the small group of individuals who account for a disproportionate share of health-care expenditures has led to research on frequent users of emergency departments and other health services, but little research has been done regarding those who use EMS services. To inform policy and intervention implementation, we undertook a descriptive analysis of EMS superusers in a large urban community. In this paper we compare EMS superusers to low, moderate, and high users to characterize factors contributing to EMS use. We also estimate the financial impact of EMS superusers. Methods. We conducted a retrospective cross-sectional study based on 1 year of data from an urban EMS system. Data for all EMS encounters with patients age ≥18 years were extracted from electronic records generated on scene by paramedics. We identified demographic and clinical variables associated with levels of EMS use. EMS users were characterized by the annual number of EMS encounters: low (1), moderate (2-4), high (5-14), and superusers (≥15). In addition, we performed a financial analysis using San Francisco Fire Department of 31,462 adults generated 43,559 EMS ambulance encounters, which resulted in 39,107 transports (a 90% transport rate). Encounters for general medical reasons were common among moderate and high users and less frequent among superusers and low users, while alcohol use was exponentially correlated with encounter frequency. Superusers were significantly younger than moderate EMS users, and more likely to be male. The superuser group created a significantly higher financial burden/person than any other group, comprising 0.3% of the study population, but over 6% of annual EMS charges and reimbursements. Conclusions. In this retrospective study, adult EMS "superusers" emerged as a distinct, predominantly male population and their EMS encounters were associated with alcohol use. Continued analysis of this unique, high-cost, and frequently transported population will likely illuminate specific intervention strategies.

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Section: Limitationsmentioning

confidence: 74%

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

Hall¹,

Raven²,

Hall³

et al. 2014

Prehospital Emergency Care

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“…Adherence to ED aftercare instructions is lower in children with public insurance and in children who present to the ED with low-acuity health problems 31 ; these 2 attributes were common among recurrent ED users both in our study and in previous ones. 9,10 Adherence may be better optimized by bolstering outpatient health services with a community health worker, telemedicine, access to an urgent care center, or retail-based clinics affiliated with a medical home.…”

Section: Discussionmentioning

confidence: 99%

“…9 Younger age, minority status, and publicly insured patients are more likely to recurrently use the ED, especially for common illnesses such as asthma and upper respiratory infections. [9][10][11][12] Little is known about the health care services (eg, medications, testing, and subsequent admission) that frequent users of pediatric EDs experience while in the ED. Understanding the health service needs of frequent users may help inform initiatives to decrease the recurrent use of pediatric EDs.…”

mentioning

confidence: 99%

Characteristics of Recurrent Utilization in Pediatric Emergency Departments

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Although frequent utilizers of emergency departments (EDs) are targeted for quality improvement initiatives across the United States, little is known about the health services these patients receive in the ED.WHAT THIS STUDY ADDS: Eight percent of children account for 24% of ED visits and 31% of all costs. Frequent utilizers of pediatric EDs, especially infants without a chronic condition, are least likely to need medications, testing, and hospital admission during their ED visits. abstract BACKGROUND AND OBJECTIVE: Nationally, frequent utilizers of emergency departments (EDs) are targeted for quality improvement initiatives. The objective was to compare the characteristics and ED health services of children by their ED visit frequency. METHODS:A retrospective study in 1 896 547 children aged 0 to 18 years with 3 263 330 visits to 37 EDs in 2011. The number of ED visits per child within 365 days of their first visit was counted. Patient characteristics (age, chronic condition) and ED care (medications, testing [laboratory and radiographic], and hospital admission) were assessed. We evaluated the relationship between patient characteristics and ED health services received with multivariable regression. RESULTS:Children with $4 ED visits (8%) accounted for 24% of all visits and 31% ($1.4 billion) of all costs. As visit frequency increased from 1 to $4, the percentage of children aged ,1 year increased (12.1% to 33.2%) and the percentage of children without a chronic condition decreased (81.9% to 45.6%) (P , .001 for both). Children with $4 ED visits had a higher percentage of visits without medication administration (aside from acetaminophen or ibuprofen), testing, or hospital admission when compared with children with 1 visit (35.4% vs 29.0%; P , .001). Children with $4 ED visits who were aged ,1 year (odds ratio: 3.8; 95% confidence interval: 3.7-3.9) and who were without a chronic condition (odds ratio: 3.1; 95% confidence interval: 3.0-3.1) had the highest likelihood of experiencing this type of visit. CONCLUSIONS:With a disproportionate share of pediatric ED cost and utilization, frequent utilizers, especially infants without a chronic condition, are the least likely to need medications, testing, and hospital admission. Pediatrics 2014;134:e1025-e1031 AUTHORS:

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“…In addition, SCH PED patient characteristics were similar to previous studies, which found that children with chronic conditions were more often boys and older. 2,12,14,15,19,[28][29][30] We found children with chronic conditions accounted for 57% of the hospital and 84% of the PICU admissions from the PED. Previous studies have found increased rates of admission from the PED for children with chronic conditions compared with children without chronic conditions, ranging from 28% to 38% vs 11% to 23% to the hospital and 1% vs 0.03% to the PICU.…”

Section: Discussionmentioning

confidence: 85%

“…10,11 Children with chronic conditions use emergency services more frequently than their nonchronic peers. 2,4,[12][13][14][15][16][17][18][19][20] The vulnerability of children with chronic medical conditions in the emergency setting, as well as the need for concise summaries of their medical condition, precautions needed, and/or special management plans, has been recognized by both the pediatric and emergency medicine communities. [21][22][23][24] Better understanding of the increasingly large and medically complex subsets of children among those with chronic conditions is critical to optimizing their emergency care.…”

mentioning

confidence: 99%

Medical Complexity and Pediatric Emergency Department and Inpatient Utilization

2013

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Children with chronic conditions use the pediatric emergency department (PED) more frequently than children without chronic conditions. To date, no one has examined how medical complexity relates to PED use and disposition.WHAT THIS STUDY ADDS: Varying degrees of medical complexity among children with chronic conditions are associated with increased PED length of stay, inpatient admission, and PED visit frequency. Clinical Risk Group software is able to identify disproportionate users of PED and hospital resources. abstract OBJECTIVES: To characterize the use of and disposition from a tertiary pediatric emergency department (PED) by children with chronic conditions with varying degrees of medical complexity. METHODS:We conducted a retrospective cohort study using a dataset of all registered PED patient visits at Seattle Children' s Hospital from January 1, 2008, through December 31, 2009. Children' s medical complexity was classified by using a validated algorithm (Clinical Risk Group software) into nonchronic and chronic conditions: episodic chronic, lifelong chronic, progressive chronic, and malignancy. Outcomes included PED length of stay (LOS) and disposition. Logistic regression generated age-adjusted odds ratios (AOR) of admission with 95% confidence intervals (CIs).RESULTS: PED visits totaled 77 748; 20% (15 433) of which were for children with chronic conditions. Compared with visits for children without chronic conditions, those for children with chronic conditions had increased PED LOS (on average, 79 minutes longer; 95% CI 77-81; P , .0001) and hospital (51% vs 10%) and PICU (3.2% vs 0.1%) admission rates (AOR 10.3, 95% CI 9.9-10.7 to hospital and AOR 25.0, 95% CI 17.0-36.0 to PICU). Admission rates and PED LOS increased with increasing medical complexity. CONCLUSIONS:Children with chronic conditions comprise a significant portion of annual PED visits in a tertiary pediatric center; medical complexity is associated with increased PED LOS and hospital or PICU admission. Clinical Risk Group may have utility in identifying high utilizers of PED resources and help support the development of interventions to facilitate optimal PED management, such as pre-arrival identification and individual emergency care plans. Pediatrics 2013;131:e559-e565

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Characteristics of frequent pediatric emergency department users

Cited by 57 publications

References 0 publications

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

Characteristics of Recurrent Utilization in Pediatric Emergency Departments

Medical Complexity and Pediatric Emergency Department and Inpatient Utilization

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