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Implementation of clinical practices to reduce return visits within 72 h to a paediatric emergency department
Jin Hee Jeong1, Seung Sik Hwang2, Kyuseok Kim3
1Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Republic of Korea.
Insights
Implementing new clinical practices significantly reduced paediatric emergency department return visits from 4.4% to 2.6%. This study demonstrates effective strategies for improving healthcare quality and patient satisfaction in paediatric emergency care.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Clinical Practice Development
Background:
- Return visits to the paediatric emergency department (PED) are a key indicator of healthcare quality and patient satisfaction.
- Previous research primarily described factors associated with return visits, lacking intervention-focused strategies.
- Developing and implementing new clinical practices is crucial for optimizing PED care and reducing revisits.
Purpose of the Study:
- To develop novel clinical practices aimed at decreasing return visits to the paediatric emergency department.
- To evaluate the effectiveness of these newly developed clinical practices in reducing paediatric patient return visits.
- To assess the impact of implemented practices on healthcare quality metrics within the PED.
Main Methods:
- A controlled before-and-after study design was employed.
- New clinical practices were informed by 2011 patient data and emergency physician/nurse surveys.
- Intervention implemented from July to November 2012, with return visit rates compared to matched 2011 periods; three independent hospitals also analyzed.
Main Results:
- Implementation of five new protocols (set orders, high-risk management, feedback, discharge instructions, early clinic visits) significantly reduced return visits from 4.4% to 2.6% (p<0.01).
- The admission rate for return visits decreased from 22.3% to 17.5%, though this was not statistically significant (p=0.37).
- Independent hospital data showed similar or increased return visit rates, highlighting the intervention's specific impact.
Conclusions:
- The developed and implemented clinical practices proved effective in significantly reducing paediatric patient return visits to the emergency department.
- These findings underscore the potential of targeted clinical practice improvements to enhance efficiency and quality in paediatric emergency care.
- The study provides a model for other institutions seeking to minimize unnecessary emergency department revisits.
Objective:
Return visits to the paediatric emergency department (PED) are an important measure of quality of healthcare and are associated with patients' and parents'/guardians' satisfaction. Previous studies have been limited to describing characteristics and factors related to return visits. The objectives of this study were to develop new clinical practices to reduce return visits to the PED and to see whether implementation of these practices had the desired effect.
Patients And Methods:
This was a controlled before-and-after study. New clinical practices were developed by analysing data for patients visiting in 2011 (before) and by surveying emergency physicians and nurses in the PED. New clinical practices were implemented between 16 July and 4 November 2012 (after). The rate of return visits and admission rates after return visits were compared between matched periods in 2011 and 2012. We also investigated return visits at three independent hospitals to overcome the limitation of the intervention application to a single hospital.
Results:
The new clinical practices included five protocols: set orders for common symptoms; management plans for patients at high risk of a return visit; a daily physician feedback system; protocolised discharge instructions; early planned visits to clinics. After implementation, the rate of return visits was reduced significantly, from 4.4% to 2.6% (p<0.01). The admission rate for return visits was also reduced, but not significantly so, from 22.3% to 17.5% (p=0.37). Return visits at the other hospitals were similar or significantly increased in 2012 compared with 2011.
Conclusions:
The development and implementation of clinical practices were effective in reducing return visits of paediatric patients to the ED.
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