Emergency department use among children with tracheostomies: Avoidable visits

Area of Science:

• Pediatric Healthcare
• Health Services Research
• Complex Chronic Conditions

Background:

• High emergency department (ED) utilization is a concern for children with tracheostomies and complex chronic conditions.
• Understanding the drivers of ED visits is crucial for optimizing care delivery and resource allocation.

Purpose of the Study:

• To characterize high ED use in pediatric patients with tracheostomies.
• To differentiate between avoidable and unavoidable ED visits.
• To quantify the financial impact of avoidable ED visits.

Main Methods:

• Analysis of administrative data to identify high ED users among children with tracheostomies.
• Expert review by interdisciplinary dyads to classify ED visits as avoidable or unavoidable.
• Calculation of hospital costs associated with avoidable visits.

Main Results:

• 31% of children with tracheostomies were high ED utilizers, accounting for 74% of all ED discharges.
• Of 312 ED visits by 19 high-utilizing children, 33% were deemed avoidable.
• Common reasons for avoidable visits included upper respiratory infections, gastrointestinal infections, and enteral feeding issues, costing the hospital $67,940.

Conclusions:

• A significant proportion of ED visits for children with tracheostomies and complex conditions may be preventable.
• Enhanced access to specialized ambulatory care teams could decrease avoidable ED visits and improve health outcomes.
• Further research is needed to evaluate the impact of such ambulatory care models on ED utilization and overall healthcare costs.