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17857

Correlation Between Unexpected Return Visits to a Pediatric Emergency Department and the Office Hours and Scheduling Times of the Primary Care Provider

Friday, October 19, 2012
Room 272-273 (Morial Convention Center)
Brent Rogers1, Magdy Attia1 and Arnel Mercado2, (1)Emergency Medicine, A.I. duPont Hospital for Children, Wilmington, DE, (2)Research Division, Nemours Children's Clinic, Jacksonville, FL

Purpose

Return visits(RVs) to the emergency department(ED) are common, affecting probability of medical error, wait time, and patient satisfaction. RVs may indicate a failure to properly assess, treat, and provide proper follow-up instructions.  We performed a retrospective chart review investigating patients seen in the A.I. duPont Hospital for Children(AIDHC) ED with RVs within 48 hours of discharge.  Our primary objective was to evaluate the time RVs occurred and determine if opening office visit times during non-traditional business hours would be justified to decrease the rate of these unscheduled RVs.  Secondary objectives included to analyze characteristics of those returning to the ED and determine independent factors associated with RVs. 

Methods

Descriptive statistics and clinical characteristics were analyzed and compared for all ED visits from 11/01/08 to 10/31/11(Group A; n=125,246).   A subset of patients with an AIDHC-associated primary care provider(PCP)(Group B; n=30231), who we would have access to information about outpatient follow-up visits and known PCP office times, was analyzed and compared to the total ED population.  We further analyzed subset patients returning to the ED within 48 hours(Group C; n=810), including if RV occurred between daytime PCP office hours(9:00am-4:59pm) or off-hours(5:00pm-8:59am).  Descriptive and clinical statistics were compared between groups for RV time and with those who followed with their PCP instead of the ED.

Results

Group B was found to be a demographical representation of Group A in most ways with differences including more black patients, more with Medicaid, and fewer with private insurance(Table).  Group A and Group B had similar rates of return, and 63% of RVs occurred after hours compared to 57.3% of all ED visits.  Group C patients were triaged as less acute but had a higher rate of admission.  Of Group B patients without RV’s, 16.7% followed up with their PCP within 48 hours.  Regression analysis to identify independent variables associated with daytime RVs is being performed and data will be provided in future presentation.

Table:

Group A

Group B

Group C

n=125,246

n=30,231

n=810

Age(Years)

5.84 ± 5.76

5.47 ± 5.18

4.74 ± 5.07

Gender

Male 53.6% 53.6% 54.3%
Female 46.4% 46.4% 45.7%
Race
Asian 0.9% 0.8% 1.3%
Black 30.0% 49.0% 43.0%
White 49.9% 31.9% 34.0%
Other 18.3% 17.7% 21.7%
Disposition
Discharged 79.0% 80.3% 65.1%
Admitted 9.1% 8.2% 18.8%
Acuity(ESI)
Five(lowest) 20.1% 23.3% 14.0%
Four 30.5% 31.4% 24.3%
Three 33.4% 30.0% 45.1%
Two 10.5% 9.8% 10.6%
One(highest) 0.1% 0.1% 0.2%
Medicaid
Yes 49.0% 65.9% 68.1%
No 51.0% 34.1% 31.9%
Private Insurance
Yes 52.7% 38.6% 37.5%
No 47.3% 61.4% 62.5%
Time of ED Visit
9am-4:59pm 42.4% 41.1% 37.0%
5pm-8:59pm 57.6% 58.9% 63.0%

Conclusion

Opening off-hour PCP office visits and awareness of the characteristics of patients likely to return to ED may decrease the burden of ED RVs.