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September 1996, Vol 150, No. 9 >
Article | September 1996

Noncompliance With Scheduled Revisits to a Pediatric Emergency Department FREE

Richard J. Scarfone, MD; Mark D. Joffe, MD; James F. Wiley, MD; John M. Loiselle, MD; Richard T. Cook, MD
Arch Pediatr Adolesc Med. 1996;150(9):948-953. doi:10.1001/archpedi.1996.02170340062012.
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Objectives:  To determine the incidence of, the risk factors associated with, and the consequences of noncompliance (NC) with a scheduled revisit to a pediatric emergency department (ED).

Design:  A prospective, inceptive cohort study.

Setting:  An urban pediatric ED.

Patients:  A sample of 179 children.

Interventions:  Interviews of parents and physicians.

Results:  Overall, 91 (51%) of the parents were noncompliant, and just 21% were noncompliant because "the child was better." Of the 124 patients who ED physicians believed were "certain to return," 57 (46%) were noncompliant. Six factors were associated with NC: (1) the parent believed that the child was not severely ill (relative risk [RR], 2.92; 95% confidence interval [CI], 1.31-6.49); (2) the parent was judged to be unable to recognize a clinical deterioration of the child (RR, 1.95; 95% CI, 1.55-2.45); (3) the parent did not own a car (RR, 1.77; 95% CI, 1.23-2.54); (4) the parent was younger than 21 years (RR, 1.48; 95% CI, 1.12-1.95); (5) no laboratory testing was performed during the initial ED visit (RR, 1.36; 95% CI, 1.03-1.80); and (6) the parent was judged "not certain" to return (RR, 1.34; 95% CI, 1.01-1.78).

Conclusions:  The high rate and the lack of predictability of NC with a scheduled revisit to an ED should influence patient disposition decisions. The factors associated with NC in this study may serve as a model for identifying parents who are at a high risk of NC and as a foundation for interventions designed to improve compliance.Arch Pediatr Adolesc Med. 1996;150:948-953

REFERENCES

1 +
Chamberlain JM, Carraccio C.  Mechanisms for follow-up from the emergency department . AJDC . 1993;;147:423. Abstract.
2 +
Baker MD, Bell LM, Avner JR.  Outpatient management without antibiotics of fever in selected infants . N Engl J Med . 1993;;329:1437-1441.
3 +
Baskin MN, O'Rourke EJ, Fleisher GR.  Outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone . J Pediatr . 1992;;120:22-27.
4 +
Jaskiewicz JA, McCarthy CA, Richardson AC, et al.  Febrile infants at low risk for serious bacterial infection: an appraisal of the Rochester criteria and implications for management . Pediatrics . 1994;;94:390-400.
5 +
Wilimas JA, Flynn PM, Harris S, et al.  A randomized study of outpatient treatment with ceftriaxone for selected febrile children with sickle cell disease . N Engl J Med . 1993;;329:472-476.
6 +
Rogers ZR, Morrison RA, Vedro DA, Buchanan GR.  Outpatient management of febrile illness in infants and young children with sickle cell anemia . J Pediatr . 1990;;117:736-739.
7 +
Field DL, Hedges JR, Arnold KJ, Goldstein-Wayne B, Rouan GW.  Limitations of chest pain follow-up from an urban teaching hospital emergency department . J Emerg Med . 1988;;6:363-368.
8 +
Magnusson AR, Hedges JR, Vanko M, McCarten K, Moorhead JC.  Follow-up compliance after emergency department evaluation . Ann Emerg Med . 1993;; 22:560-567.
9 +
Nelson EW, Van Cleve S, Swartz MK, Kessen W, McCarthy PL.  Improving the use of early follow-up care after emergency department visits . AJDC . 1991;; 145:440-444.
10 +
Jones SL, Jones PK, Katz J.  Compliance in acute and chronic patients receiving a health belief model intervention in the emergency department . Soc SciMed . 1991;;32:1183-1189.
11 +
Macharia WM, Leon G, Rowe BH, Stephenson BJ, Haynes RB.  An overview of interventions to improve compliance with appointment keeping for medical services . JAMA . 1992;;267:1813-1817.
12 +
Eraker SA, Kirscht JP, Becker MH.  Understanding and improving patient compliance . Ann Intern Med . 1984;;100:258-268.
13 +
Weitzman M, Moomaw MS, Messenger KP.  An after-hours pediatric walk-in clinic for an entire urban community: utilization and effectiveness of follow-up care . Pediatrics . 1980;;65:964-970.
14 +
Fletcher SW, Appel FA, Bourgois M.  Improving emergency room patient follow up in a metropolitan teaching hospital . N Engl J Med . 1974;;291:385-388.
15 +
Sommer KE, Angiolillo D.  The nature of emergency room follow-up care . JAMA . 1974;;29:547-551.
16 +
Vukmir RB, Kremen R, Ellis GL, DeHart DA, Plewa MC, Menegazzi J.  Compliance with emergency department referral: the effect of computerized discharge instructions . Ann Emerg Med . 1993;;22:819-823.
17 +
Fosarelli P, DeAngelis C, Kaszuba A.  Compliance with follow-up appointments generated in a pediatric emergency room . Am J Prev Med . 1985;;1:23-29.
18 +
Avner JR, Baker MD.  Follow-up in an urban emergency department: how reliable? Pediatr Emerg Care . 1990;:6:221. Abstract.
19 +
Chande VT, Exum V.  Follow-up phone calls from the emergency department improve parental compliance with discharge instructions . AJDC . 1993;;147: 441. Abstract.
20 +
Jones PK, Jones SL, Katz J.  Improving compliance for asthmatic patients visiting the emergency department using a health belief model intervention . J Asthma . 1987;;24:199-206.
21 +
Kahn L, Anderson M, Perkoff GT.  Patient's perceptions and uses of a pediatric emergency room . Soc Sci Med . 1973;;7:155-160.
22 +
DeAngelis C, Joffe A, Wilson M, Willis E.  latrogenic risks and financial costs of hospitalizing febrile infants . AJDC . 1983;;137:1146-1149.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Chamberlain JM, Carraccio C.  Mechanisms for follow-up from the emergency department . AJDC . 1993;;147:423. Abstract.
2 +
Baker MD, Bell LM, Avner JR.  Outpatient management without antibiotics of fever in selected infants . N Engl J Med . 1993;;329:1437-1441.
3 +
Baskin MN, O'Rourke EJ, Fleisher GR.  Outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone . J Pediatr . 1992;;120:22-27.
4 +
Jaskiewicz JA, McCarthy CA, Richardson AC, et al.  Febrile infants at low risk for serious bacterial infection: an appraisal of the Rochester criteria and implications for management . Pediatrics . 1994;;94:390-400.
5 +
Wilimas JA, Flynn PM, Harris S, et al.  A randomized study of outpatient treatment with ceftriaxone for selected febrile children with sickle cell disease . N Engl J Med . 1993;;329:472-476.
6 +
Rogers ZR, Morrison RA, Vedro DA, Buchanan GR.  Outpatient management of febrile illness in infants and young children with sickle cell anemia . J Pediatr . 1990;;117:736-739.
7 +
Field DL, Hedges JR, Arnold KJ, Goldstein-Wayne B, Rouan GW.  Limitations of chest pain follow-up from an urban teaching hospital emergency department . J Emerg Med . 1988;;6:363-368.
8 +
Magnusson AR, Hedges JR, Vanko M, McCarten K, Moorhead JC.  Follow-up compliance after emergency department evaluation . Ann Emerg Med . 1993;; 22:560-567.
9 +
Nelson EW, Van Cleve S, Swartz MK, Kessen W, McCarthy PL.  Improving the use of early follow-up care after emergency department visits . AJDC . 1991;; 145:440-444.
10 +
Jones SL, Jones PK, Katz J.  Compliance in acute and chronic patients receiving a health belief model intervention in the emergency department . Soc SciMed . 1991;;32:1183-1189.
11 +
Macharia WM, Leon G, Rowe BH, Stephenson BJ, Haynes RB.  An overview of interventions to improve compliance with appointment keeping for medical services . JAMA . 1992;;267:1813-1817.
12 +
Eraker SA, Kirscht JP, Becker MH.  Understanding and improving patient compliance . Ann Intern Med . 1984;;100:258-268.
13 +
Weitzman M, Moomaw MS, Messenger KP.  An after-hours pediatric walk-in clinic for an entire urban community: utilization and effectiveness of follow-up care . Pediatrics . 1980;;65:964-970.
14 +
Fletcher SW, Appel FA, Bourgois M.  Improving emergency room patient follow up in a metropolitan teaching hospital . N Engl J Med . 1974;;291:385-388.
15 +
Sommer KE, Angiolillo D.  The nature of emergency room follow-up care . JAMA . 1974;;29:547-551.
16 +
Vukmir RB, Kremen R, Ellis GL, DeHart DA, Plewa MC, Menegazzi J.  Compliance with emergency department referral: the effect of computerized discharge instructions . Ann Emerg Med . 1993;;22:819-823.
17 +
Fosarelli P, DeAngelis C, Kaszuba A.  Compliance with follow-up appointments generated in a pediatric emergency room . Am J Prev Med . 1985;;1:23-29.
18 +
Avner JR, Baker MD.  Follow-up in an urban emergency department: how reliable? Pediatr Emerg Care . 1990;:6:221. Abstract.
19 +
Chande VT, Exum V.  Follow-up phone calls from the emergency department improve parental compliance with discharge instructions . AJDC . 1993;;147: 441. Abstract.
20 +
Jones PK, Jones SL, Katz J.  Improving compliance for asthmatic patients visiting the emergency department using a health belief model intervention . J Asthma . 1987;;24:199-206.
21 +
Kahn L, Anderson M, Perkoff GT.  Patient's perceptions and uses of a pediatric emergency room . Soc Sci Med . 1973;;7:155-160.
22 +
DeAngelis C, Joffe A, Wilson M, Willis E.  latrogenic risks and financial costs of hospitalizing febrile infants . AJDC . 1983;;137:1146-1149.

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