Does Nursery-Based Intensified Anticipatory Guidance Reduce Emergency Department Use for Nonurgent Conditions in the First Month of Life? A Randomized Controlled Trial

Abstract

Objective. We aimed to evaluate the impact of an intensified anticipatory guidance program in the nursery on Emergency Department (ED) use for nonurgent conditions (NUCs) in the neonatal period. Methods. Parturient mothers of healthy newborns were randomized to an intervention group or control group. Baseline and 1-month follow-up knowledge surveys regarding newborn care were conducted. The primary outcome was the proportion of neonates who used the ED for a NUC. Secondary outcome was change in caregivers' knowledge on NUC. Results. Of a total of 594 mothers, 323 (54%) agreed to participate and were randomized to intervention (n = 170) or control (n = 153) group. Most were Hispanic (68%), single (61%), primiparous (39%), and without high school diploma (44%). 35 (21%) neonates in the intervention group and 41 (27%) in the control group were brought at least once for a NUC to the ED (p = 0.12). There was no statistically significant difference in within subject change on knowledge scores between the two study arms. Conclusions. Neonatal ED visits for NUCs occur frequently. This nursery-based intensified anticipatory guidance program had no statistically significant impact on neonatal ED use for NUC, nor on neonatal care-relevant knowledge among parturient mothers. Alternative modalities and timing of parental educational intervention may need to be considered. This trial is registered with Clinical Trials Number NCT01859065 (Clinicaltrials.gov).

Characteristics of non‐urgent neonatal presentations to an Australian metropolitan emergency department

“…Alternative methods to educate parents should be considered. 18 In contrast to this outcome, a study by Herman et al, involving a low literacy training intervention by providing a book with basic interventions for common paediatric illnesses resulted in a significant decrease in ED and doctor visits. 19 Similarly, a study by Grant et al examining the effect of a short programme that aimed at providing education on how to deal with common childhood illnesses to parents and advising for review by primary care provider before seeking ED care showed a decrease in NUPs among the study group who received an education.…”

“…This contrasts with previous studies, which found decreased presentation rates, decreased NUPs and increased admission rates. 17,18,20,21 It would be worthwhile to see whether there is any change in presentations/admission post-Delta variant where the caseloads were much higher than had been seen the year prior. Further studies are warranted to elucidate this.…”

Retrospective observational study of neonatal attendances to a children's emergency department

“…Support and education for new parents highlighting these potential issues, whilst taking into account factors such as media‐induced fear and access to primary care, are likely to be crucial interventions if this trend is to be reversed 18 . Capitalising on technological advances may be of benefit, with one Internet‐based home monitoring system resulting in reduced neonatal ED attendances, 19 but such community‐based interventions may not always have the expected impact if attitudes towards ED use are not considered 20 …”

“…18 Capitalising on technological advances may be of benefit, with one Internet-based home monitoring system resulting in reduced neonatal ED attendances, 19 but such community-based interventions may not always have the expected impact if attitudes towards ED use are not considered. 20 Any policy aimed at appropriate use of non-hospital healthcare resources should focus on some key patient cohorts and ensure the model of care is feasible and acceptable. A larger proportion of neonates in this study were 'well babies' when compared to European cohorts 9,21 though this may reflect literature-based or clinician differences in defining pathology.…”

Neonatal Presentations to the Children’s Emergency Department

“…Support and education for new parents highlighting these potential issues, while taking into account factors such as media-induced fear and access to primary care, are likely to be crucial interventions if this trend is to be reversed (18). Capitalising on technological advances may be of benefit, with one internet-based home monitoring system resulting in reduced neonatal ED attendances, (19) but such community based interventions may not always have the expected impact if attitudes towards ED use are not considered (20).…”