Preventing or accelerating emergency care for children with complex healthcare needs

Area of Science:

• Pediatric Healthcare Management
• Chronic Disease Care Coordination
• Emergency Department Utilization

Background:

• Children with special health care needs (CSHCN) often have complex conditions requiring frequent emergency department (ED) visits.
• Effective management and clinician advice can potentially prevent some ED visits or reduce associated time.

Purpose of the Study:

• To determine the feasibility of an ED-based advice and coordination program.
• To assess if such a program could prevent or accelerate ED care for CSHCN.

Main Methods:

• Enrolled CSHCN with frequent ED attendance in the Accelerated Care through Emergency (ACE) program.
• Provided 24-hour mobile-phone access to experienced ED nurses for advice and coordination.
• Prospectively tracked ED visit rates post-advice, waiting times, parental satisfaction, and program costs.

Main Results:

• Program enrollment grew, with participants having diverse and complex medical conditions.
• Phone call volume increased, with a significant drop in the percentage of ED reviews per phone call (74.2% to 50.0%).
• Parental satisfaction was high (8.3/10), with mean ED waiting times under 30 minutes; cost was approximately AU$750 per child annually.

Conclusions:

• Developed a coordinated healthcare approach for families with severe chronic conditions and frequent ED presentations.
• The ACE program, including care plans and 24-hour access, enhanced families' ability to manage their children's conditions in the community.