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Indigent children who are denied care in the emergency department
K N Shaw1, S M Selbst, F M Gill
1Emergency Department, Children's Hospital of Philadelphia, Pennsylvania 19104.
Insights
A study of 588 children denied emergency care found that many lacked follow-up. Of those with appointments, some received antibiotics or further evaluation, but significant gaps in health outcome data persist.
Area of Science:
- Pediatrics
- Public Health
- Health Systems Research
Background:
- A new primary-care case management system impacted 100,000 indigent patients.
- Emergency department (ED) care denial for children necessitates understanding health outcomes.
Purpose of the Study:
- To assess diagnoses and outcomes for children denied ED care.
- To evaluate the effectiveness of follow-up mechanisms within the new health system.
Main Methods:
- A six-month prospective study of 588 children denied ED care.
- Follow-up data collected from primary care physicians and parents.
- Analysis of presenting complaints, diagnoses, and treatment received.
Main Results:
- Common complaints included colds, earaches, rash, vomiting, and diarrhea.
- Follow-up data was incomplete for 45% of children.
- Of those with appointments, 42% received antibiotics; 3% were referred; 2 were hospitalized.
Conclusions:
- Significant gaps exist in tracking health outcomes for children denied ED care.
- The primary-care case management system requires improved follow-up strategies.
- Further research is needed to ensure continuity of care and patient safety.
Abstract:
We conducted a six-month prospective study of the diagnoses and outcomes of 588 children who were denied care in our emergency department under a new primary-care case management health system for 100,000 indigent patients. The mean patient age was 4.7 years (39% were less than 2 years old). The most common presenting complaints were colds, earaches, rash, vomiting, and diarrhea. Nine percent of children presented for trauma, and 10% had fever of more than 38.2 C. Follow-up was available from the primary care physician for 388 children (66%). Of the 60% of patients who kept their arranged appointment, 42% received antibiotics, 3% were referred for further evaluation, and two children were hospitalized. Follow-up was available from the parents for 125 children (21%). No follow-up information of any kind was available for 111 children (19%), and no follow-up regarding the health of the child was available for 265 children (45%). This last group included 10% with a chief complaint of trauma and 6% with temperature of more than 39 C. Forty-nine percent of patients in this group were less than 2 years old.