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Educational Interventions to Alter Pediatric Emergency Department Utilization Patterns FREE

V. T. Chande, MD; N. Wyss, MEd; V. Exum, RN
Arch Pediatr Adolesc Med. 1996;150(5):525-528. doi:10.1001/archpedi.1996.02170300079015.
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Objective:  To test the hypothesis that educating parents about use of their primary care provider and providing information about common pediatric illnesses will reduce visits to the pediatric emergency department (PED).

Design:  Prospective, randomized, controlled trial conducted from September 1, 1993, to October 31, 1994.

Setting:  Pediatric emergency department of an urban university hospital.

Participants:  Parents of 130 patients seen in the PED for minor illness.

Interventions:  Subjects were randomized to intervention or control groups. Parents in both groups were interviewed about their child's health and use of health care services. The intervention group received education on pediatric health care issues; the control group received usual PED discharge instructions. Use of the PED by all subjects was tracked for 6 months by telephone follow-up and medical record review.

Main Outcome Measures:  Differences between the two groups in total number of return visits to the PED and return visits to the PED for minor illness.

Results:  Sixty-seven (97%) of the 69 patients in the intervention group and 56 (92%) of the 61 patients in the control group identified a primary care provider. At 6-month follow-up, 21 patients (30%) from the intervention group and 16 (26%) from the control group had returned to the PED (P=.68, X2). Seventeen (81%) of intervention group returnees to the PED had minor illness, as did 11 (69%) of control group returnees.

Conclusions:  A one-time educational intervention in the PED does not alter long-term emergency department utilization habits. More extensive education and greater availability of primary care providers may be needed to decrease use of the PED for minor illness.(Arch Pediatr Adolesc Med. 1996;150:525-528)

REFERENCES

Baker DW, Stevens CD, Brook RH.  Regular source of ambulatory care and medical care utilization by patients presenting to a public hospital emergency department . JAMA . 1994;;271:1909-1912.
Rask KJ, Williams MV, Parker RM, McNagny SE.  Obstacles predicting lack of regular provider and delays in seeking care for patients at an urban public hospital . JAMA . 1994;;271:1931-1933.
Pane GA, Farner MC, Salness KA.  Health care access problems of medically indigent emergency department walk-in patients . Ann Emerg Med . 1991;;20:730-733.
Wood DL, Hayward RA, Corey CR, et al.  Access to medical care for children and adolescents in the United States . Pediatrics . 1990;;86:666-673.
Jones PK, Jones SL, Katz J.  A randomized trial to improve compliance in urinary tract infection patients in the emergency department . Ann Emerg Med . 1990;:19:16-20.
Chande VT, Exum V.  Follow-up phone calls after an emergency department visit . Pediatrics . 1994;;93:513-514.
Chande VT, Krug SE, Warm EF.  Pediatric emergency department utilization habits vary with insurance status . Pediatr Emerg Care . 1993;;9:319.
Powers RD.  Emergency department patient literacy and the readability of patient-directed materials . Ann Emerg Med . 1988;;17:124-126.
Williams M, Manske P.  Efficacy of audiovisual tape versus verbal instructions on crutch walking: a comparison . J Emerg Nurs . 1987;;13:156-159.
Smith RD, McNamara JJ.  Why not your pediatrician's office? a study of weekday pediatric emergency department use for minor illness care in a community hospital . Pediatr Emerg Care . 1988;;4:107-111.
Pachter LM, Ludwig S, Groves A.  Night people: utilization of a pediatric emergency department during the late night . Pediatr Emerg Care . 1991;;7:12-14.
Halperin R, Meyers A, Alpert J.  Utilization of pediatric emergency services: a critical review . Pediatr Clin North Am . 1979;;26:747-757.

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References

Baker DW, Stevens CD, Brook RH.  Regular source of ambulatory care and medical care utilization by patients presenting to a public hospital emergency department . JAMA . 1994;;271:1909-1912.
Rask KJ, Williams MV, Parker RM, McNagny SE.  Obstacles predicting lack of regular provider and delays in seeking care for patients at an urban public hospital . JAMA . 1994;;271:1931-1933.
Pane GA, Farner MC, Salness KA.  Health care access problems of medically indigent emergency department walk-in patients . Ann Emerg Med . 1991;;20:730-733.
Wood DL, Hayward RA, Corey CR, et al.  Access to medical care for children and adolescents in the United States . Pediatrics . 1990;;86:666-673.
Jones PK, Jones SL, Katz J.  A randomized trial to improve compliance in urinary tract infection patients in the emergency department . Ann Emerg Med . 1990;:19:16-20.
Chande VT, Exum V.  Follow-up phone calls after an emergency department visit . Pediatrics . 1994;;93:513-514.
Chande VT, Krug SE, Warm EF.  Pediatric emergency department utilization habits vary with insurance status . Pediatr Emerg Care . 1993;;9:319.
Powers RD.  Emergency department patient literacy and the readability of patient-directed materials . Ann Emerg Med . 1988;;17:124-126.
Williams M, Manske P.  Efficacy of audiovisual tape versus verbal instructions on crutch walking: a comparison . J Emerg Nurs . 1987;;13:156-159.
Smith RD, McNamara JJ.  Why not your pediatrician's office? a study of weekday pediatric emergency department use for minor illness care in a community hospital . Pediatr Emerg Care . 1988;;4:107-111.
Pachter LM, Ludwig S, Groves A.  Night people: utilization of a pediatric emergency department during the late night . Pediatr Emerg Care . 1991;;7:12-14.
Halperin R, Meyers A, Alpert J.  Utilization of pediatric emergency services: a critical review . Pediatr Clin North Am . 1979;;26:747-757.

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