Repeat Pediatric Visits to a General Emergency Department

Zimmerman, Deena; McCarten-Gibbs, Kevan A; DeNoble, Denise H; Borger, Caryn; Fleming, Jacqueline; Hsieh, Margaret; Langer, Jessica; Breckenridge, Mary B.

doi:10.1016/s0196-0644(96)70107-5

Cited by 65 publications

(59 citation statements)

References 23 publications

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“…Respiratory diagnoses were also reported as the most common diagnoses during return visits in other studies. (9) This was not unexpected, as respiratory conditions have the potential to deteriorate more rapidly. However, we found that patients diagnosed with gastrointestinal complaints were more likely to be admitted compared to respiratory diagnoses, and the underlying cause and significance requires further investigation.…”

Section: Discussionmentioning

confidence: 96%

“…The patient's age was found to be inversely proportional to the reattendance rate at our ED, consistent with preceding studies. (1,7,9) Young patients are often unable to express their discomfort, leading to ambiguity in signs and symptoms. Parents, especially first-time parents, may also have a lower threshold to revisit the ED for any change in symptoms or concerns in younger patients.…”

Section: Discussionmentioning

confidence: 99%

“…Public insurance has often been associated with a higher reattendance rate compared to private insurance. (3,9,13) Parental patterns of healthcare use have also been shown to influence the use of ED visits for their children. (32) Efforts to educate parents may potentially reduce the reattendance rate.…”

Section: Discussionmentioning

confidence: 99%

“…(1,2,5,6) Reattendances may be due to illness progression (3,7,8) or parental preference for ED care, (5) but may also reflect failure to appropriately diagnose, treat and communicate follow-up advice at the first visit. (2,3,(7)(8)(9) In the paediatric population, parental concern or anxiety may play a significant role. (3,7,10) Higher reattendance rates may, therefore, indicate suboptimal clinical care or failure to address parental concerns at the first visit.…”

Section: Introductionmentioning

confidence: 99%

“…(8) A majority of studies have associated reattendance with young age; higher acuity; attendance during the busiest hours; presence of chronic illness; infectious disease or respiratory diagnoses; and higher rates of admission. (1)(2)(3)7,9,13) In particular, children with chronic diseases have complex multidisciplinary care needs and may present to the ED more frequently when alternative sources of care are not available. (14)(15)(16) In the present study, our primary objective was to determine the rate and characteristics of reattendances at our paediatric ED within 72 hours from the first visit.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Unplanned reattendances at the paediatric emergency department within 72 hours: a one-year experience in KKH

Goh¹,

Huang²,

Kong³

et al. 2015

smedj

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Unplanned reattendances at the paediatric emergency department within 72 hours: a one-year experience in KKH

Goh¹,

Huang²,

Kong³

et al. 2015

smedj

View full text Add to dashboard Cite

Appropriateness of Urgent Referrals by Nurses at a Hospital-Based Pediatric Call Center

Kempe

Dempsey²,

Whitefield³

et al. 2000

Arch Pediatr Adolesc Med

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Objectives: To evaluate (1) the appropriateness of the after-hours referral (AHR), (2) clinical characteristics of urgently referred patients, and (3) parental compliance with disposition recommendations by the After-Hours Call Center of the Children's Hospital, Denver, Colo. Subjects:Patients of Denver, Colo, pediatricians who called after office hours were triaged by nurses using a computerized triage system, and were referred for afterhours evaluation to 1 of 5 urgent care sites (N = 409).Design: Data were collected at each site for 2-week periods every 3 months, from October 1996 to October 1997 (total study period, 10 weeks). Appropriateness of AHRs (diagnoses, clinical interventions, and final dispositions) were determined by a questionnaire that was completed by the evaluating physician. Parental compliance with the AHR was assessed by review of the after-hours site patient database and by telephone survey. Results:Of the referred patients, 339 (82.9%) complied with the recommendation for AHR and, of these, physician questionnaires were completed for 332 (97.9%). The mean percentage of evaluated patients judged appropriate was 90.7% and did not differ statistically by site or by physician training. A history indicating a potentially serious condition was the most common reason for judging a referral appropriate (80.1%), followed by patient discomfort (53.3%), findings from a physical examination (42.5%), parental anxiety (41.5%), and an urgent need for diagnostic test or therapy (34.7%). Of evaluated patients, 37.0% had a diagnostic test, and in 43.5% of cases, the evaluating physician thought a therapeutic intervention was necessary that night. Of the total sample, 93.4% were discharged and 6.6% were admitted to the hospital. The major reasons given by families for noncompliance were lack of understanding of the disposition recommendation and disagreement with the need for urgent referral.Conclusions: Approximately 90% of patients who complied with a referral for urgent evaluation by the AfterHours Call Center were judged by the evaluating physician to have been appropriately referred. The appropriateness rate for all referrals may be lower if there is significant self-selection in those families who do not comply.

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Prevalence and predictors of return visits to pediatric emergency departments

Akenroye

Thurm

Neuman

et al. 2014

Journal of Hospital Medicine

100

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OBJECTIVE:To determine the rate of return visits to pediatric emergency departments (EDs) and identify patient-and visit-level factors associated with return visits and hospitalization upon return. DESIGN AND SETTING:Retrospective cohort study of visits to 23 pediatric EDs in 2012 using data from the Pediatric Health Information System. PARTICIPANTS:Patients <18 years old discharged following an ED visit. MEASURES:The primary outcomes were the rate of return visits within 72 hours of discharge from the ED and of return visits within 72 hours resulting in hospitalization. Results: 1,415,721 of the 1,610,201 ED visits to study hospitals resulted in discharge. Of the discharges, 47,294 patients (3.3%) had a return visit. Of these revisits, 9295 (19.7%) resulted in hospitalization. In multivariate analyses, the odds of having a revisit were higher for patients with a chronic condition (odds ratio [OR]

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Repeat Pediatric Visits to a General Emergency Department

Cited by 65 publications

References 23 publications

Unplanned reattendances at the paediatric emergency department within 72 hours: a one-year experience in KKH

Unplanned reattendances at the paediatric emergency department within 72 hours: a one-year experience in KKH

Appropriateness of Urgent Referrals by Nurses at a Hospital-Based Pediatric Call Center

Prevalence and predictors of return visits to pediatric emergency departments

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