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Improving the use of early follow-up care after emergency department visits. A randomized trial
E W Nelson1, S Van Cleve, M K Swartz
1Department of Pediatrics, Yale University School of Medicine, New Haven, Conn.
Insights
Post-visit nurse practitioner support improved parents' adherence to follow-up care recommendations after emergency department (ED) visits for children. This intervention enhanced appropriate care utilization for young patients.
Area of Science:
- Pediatric emergency medicine
- Healthcare quality improvement
- Primary care coordination
Background:
- Emergency departments (EDs) often manage acute childhood illnesses.
- Ensuring appropriate follow-up care after ED visits is crucial for continuity and quality of care.
- Current follow-up practices may be suboptimal, leading to missed appointments or inappropriate care seeking.
Observation:
- A randomized controlled trial was conducted in an urban university hospital ED.
- 190 children under 8 years old treated as outpatients were included.
- Parents received either usual ED advice or post-visit support from a nurse practitioner.
Findings:
- Nurse practitioner intervention significantly improved parental compliance with follow-up instructions (79% vs. 61%).
- Experimental group showed reduced appointment no-shows (15% vs. 31%) and 'doctor shopping' (2% vs. 9%).
- Appropriate follow-up care use increased, with inappropriate care reduced from 20% to 10% in the intervention group.
Implications:
- Post-visit nurse practitioner support is effective in enhancing appropriate follow-up care after pediatric ED visits.
- This intervention model can improve the overall care for children with episodic ED use.
- Integrating such support systems can optimize healthcare resource utilization and patient outcomes.
Objective:
To test the hypothesis that the appropriateness of parents' use of early follow-up care after emergency department (ED) visits can be improved by postvisit support from a nurse practitioner.
Design:
Randomized controlled trial, single blinded.
Setting:
Urban university hospital ED linked to hospital's primary care center.
Participants:
Parents of 190 children younger than 8 years who sought care in the ED for acute illnesses and who were treated as outpatients with primary care center follow-up at the discretion of ED clinicians.
Intervention:
Parents in the experimental group were called by a nurse practitioner who offered both individualized guidance regarding follow-up and access to a nurse practitioner for further help as needed. The control group received "usual" follow-up advice during ED visits.
Measurements/Main Results:
In the week after the ED visits, parents in the experimental group, compared with parents in the control group, were more compliant with instructions regarding follow-up (79% vs 61%), less apt to miss appointments (15% vs 31%), and less apt to "shop" elsewhere for care (2% vs 9%). Appropriateness of follow-up was assessed in "blinded" fashion using preestablished guidelines. Inappropriate use of follow-up care was significantly reduced among experimental group subjects (10% vs 20%).
Conclusion:
The nurse practitioner's intervention improved parents' use of follow-up care in our sample. Overall care for episodic ED users might be improved by similar interventions.
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