Comparative Practice Patterns of Emergency Medicine Physicians and Pediatric Emergency Medicine Physicians Managing Fever in Young Children

Isaacman, Daniel J.; Kaminer, K.; Veligeti, H. V.; Jones, M. C.; Davis, Paris; Mason, Jon D.

doi:10.1542/peds.108.2.354

Cited by 79 publications

(63 citation statements)

References 17 publications

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“…However, these were relatively small and entirely in kind. [41][42][43] From this effort, we have learned that guideline implementation can be successful even in a busy setting such as the ED. More important, we found that provider buy-in is crucial to successful implementation.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

et al. 2014

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OBJECTIVE: Bronchiolitis is a major cause of infant morbidity and contributes to millions of dollars in health care costs. Care guidelines may cut costs by reducing unnecessary resource utilization. Through the implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of care provided to infants with bronchiolitis in a pediatric emergency department (ED). METHODS:We conducted an interrupted time series that examined ED visits of 2929 patients with bronchiolitis, aged 1 to 12 months old, seen between November 2007 and April 2013. Outcomes were proportion having a chest radiograph (CXR), respiratory syncytial virus (RSV) testing, albuterol or antibiotic administration, and the total cost of care. Balancing measures included admission rate, returns to the ED resulting in admission within 72 hours of discharge, and ED length of stay (LOS).RESULTS: There were no significant preexisting trends in the outcomes. After guideline implementation, there was an absolute reduction of 23% in CXR (95% confidence interval [CI]: 11% to 34%), 11% in RSV testing (95% CI: 6% to 17%), 7% in albuterol use (95% CI: 0.2% to 13%), and 41 minutes in ED LOS (95% CI: 16 to 65 minutes). Mean cost per patient was reduced by $197 (95% CI: $136 to $259). Total cost savings was $196 409 (95% CI: $135 592 to $258 223) over the 2 bronchiolitis seasons after guideline implementation. There were no significant differences in antibiotic use, admission rates, or returns resulting in admission within 72 hours of discharge.CONCLUSIONS: A bronchiolitis guideline was associated with reductions in CXR, RSV testing, albuterol use, ED LOS, and total costs in a pediatric ED. Pediatrics 2014;133:e227-e234 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

et al. 2014

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“…48 However, applying measures only to institutions with a particular volume of high acuity cases would miss a significant portion of patients who are seen in smaller centers, and it is in these centers where practice variation and the potential for improvement may be greatest. 21,[24][25][26]49 Many of the indicators developed here would be useful even for smaller volume centers for local quality improvement initiatives, such as measuring the impact of a new clinical pathway. Another solution already in use by the US Department of Health and Human Services is to aggregate data over 3 years.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18] Evidence indicates that there is substantial practice variation for pediatric patients among emergency care providers, and that many providers do not optimally manage seriously injured or ill children. [19][20][21] Most of the recent work on practice variation and lack of adherence to practice guidelines in the pediatric ED setting has been done on common, often lower acuity conditions, [21][22][23][24][25][26] despite evidence of a similar gap between knowledge and practice in severely ill and injured children. 20 Identifying gaps in care for high acuity conditions, where improvement is likely to have the largest impact on quality of life and longevity, 19 requires valid and reliable quality indicators.…”

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confidence: 99%

Quality Indicators for High Acuity Pediatric Conditions

et al. 2013

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OBJECTIVE: Identifying gaps in care and improving outcomes for severely ill children requires the development of evidence-based performance measures. We used a systematic process involving multiple stakeholders to identify and develop evidence-based quality indicators for high acuity pediatric conditions relevant to any emergency department (ED) setting where children are seen. METHODS:A prioritized list of clinical conditions was selected by an advisory panel. A systematic review of the literature was conducted to identify existing indicators, as well as guidelines and evidence that could be used to inform the creation of new indicators. A multiphase, Rand-modified Delphi method consisting of anonymous questionnaires and a face-to-face meeting of an expert panel was used for indicator selection. Measure specifications and evidence grading were created for each indicator, and the feasibility and reliability of measurement was assessed in a tertiary care pediatric ED. RESULTS:The conditions selected for indicator development were diabetic ketoacidosis, status asthmaticus, anaphylaxis, status epilepticus, severe head injury, and sepsis. The majority of the 62 selected indicators reflect ED processes (84%) with few indicators reflecting structures (11%) or outcomes (5%). Thirty-seven percent (n = 23) of the selected indicators are based on moderate or high quality evidence. Data were available and interrater reliability acceptable for the majority of indicators. CONCLUSIONS:A systematic process involving multiple stakeholders was used to develop evidence-based quality indicators for high acuity pediatric conditions. Future work will test the reliability and feasibility of data collection on these indicators across the spectrum of ED settings that provide care for children . Pediatrics 2013;132:752-762

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“…Several studies have been published, however, that examine differences between pediatric and general emergency departments in the management of bronchiolitis and, as well, several other diseases. [47][48][49][50][51][52][53] Although several studies used surveys to assess opinions regarding various management strategies, [47][48][49] some also used a retrospective methodology to establish actual differences in practice patterns between pediatric and general emergency physicians. 50 -53 In general, retrospective studies are thought to provide poorer quality data than that obtained from a prospective study design.…”

Section: Discussionmentioning

confidence: 99%

Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments

et al. 2002

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ABSTRACT. Objective. It is uncertain whether pediatric and general emergency departments have different admitting practices regarding children with bronchiolitis. The objective of this study was to quantify the differences in admission practices between pediatric and general emergency departments of children with bronchiolitis in 1 North American metropolitan area, controlling for various factors such as clinical severity, comorbid conditions, and socioeconomic status.Design. Retrospective cohort review of emergency department visits from April 1992 to March 1997.Setting. Five emergency departments (1 pediatric and 4 general) serving the Calgary Health Region, which encompasses ϳ850 000 people.Patients. All children residing within the region who visited a regional emergency department and were diagnosed to have bronchiolitis (International Classification of Diseases, Ninth Revision code 466.1, primary or secondary diagnosis).Main Outcome Measure. Population-standardized estimates of admission rates.Results. The medical charts of 3091 children diagnosed to have bronchiolitis during the study period were reviewed. Of this number, 2496 children were evaluated at the pediatric emergency department, and 629 (25%) were admitted. The remaining 595 (19%) were evaluated at the general emergency departments, and 221 (37%) were admitted. Controlling for age, gender, estimated family income based on postal code, medical comorbidity, and clinical severity estimated by presenting respiratory rate and room air oxygen saturation, populationstandardized estimates for admission rates at the pediatric and general emergency departments were 24% (standard error: 1%) and 43% (standard error: 2%), respectively.Conclusion. Children diagnosed to have bronchiolitis at the Calgary Health Region's pediatric emergency department were about half as likely to be admitted to the hospital as children diagnosed at the region's general emergency departments. Pediatrics 2002;110(4). URL: http://www.pediatrics.org/cgi/content/full/110/4/e49; bronchiolitis, hospitalization rates, practice variation, emergency department. ABBREVIATIONS. CHR, Calgary Health Region; International Classification of Diseases, Ninth Revision; CI, confidence interval. B ronchiolitis is an extremely common childhood disease that accounts for a significant proportion of pediatric hospitalizations. 1 Investigators, using the technique of small-area analysis, have found marked variations in hospitalization rates of children with bronchiolitis with reports of up to sixfold differences in rates per 100 000 children. [2][3][4] This degree of variation is not unique to bronchiolitis, in that substantial variations in rates have been documented for a number of surgical procedures and diseases. 5,6 Although controversy exists as to which factors, in general, are most responsible for the variability in medical practices, in most cases differences in health care access and socioeconomic factors account for at least some proportion of the variability. 5,6 Likewise, in the case of b...

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Comparative Practice Patterns of Emergency Medicine Physicians and Pediatric Emergency Medicine Physicians Managing Fever in Young Children

Cited by 79 publications

References 17 publications

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis

Quality Indicators for High Acuity Pediatric Conditions

Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments

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