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Emergency Department-Based Care Transitions for Pediatric Patients: A Systematic Review
Joanna Abraham1, Thomas Kannampallil2, Rachel N Caskey3
1Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, abrahamj@uic.edu.
Insights
Emergency department (ED) care transition interventions significantly improve pediatric outpatient follow-up rates. However, these interventions do not appear to reduce hospital readmissions, indicating a need for further research.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Quality Improvement
Background:
- Effective care transitions from emergency departments (EDs) to outpatient settings are crucial for patient outcomes and healthcare costs.
- Pediatric care transitions present unique challenges, necessitating targeted interventions.
Purpose of the Study:
- To evaluate the efficacy of ED-based interventions in enhancing outpatient follow-up for pediatric patients.
- To assess the impact of these interventions on ED readmission rates.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
- Searched multiple databases including Medline, Embase, CINAHL, and Cochrane Library.
- Data from 16 RCTs involving 3760 pediatric patients were synthesized using a random effects model.
Main Results:
- ED-based interventions demonstrated a 29% increase in outpatient follow-up rates (OR, 1.58).
- Successful strategies included telephone reminders, educational counseling, and appointment scheduling.
- Interventions showed little to no effect on reducing ED readmissions (RR, 1.02).
Conclusions:
- ED-based care transition interventions are effective in improving pediatric outpatient follow-up.
- Current evidence suggests these interventions do not significantly decrease ED readmissions.
- Further research is needed to understand factors influencing intervention success and to explore mechanisms for reducing readmissions.
Context:
Successful care transitions between emergency departments (EDs) and outpatient settings have implications for quality, safety, and cost of care.
Objective:
To investigate the effectiveness of ED-based care transition interventions in achieving outpatient follow-up among pediatric patients.
Data Sources:
Medline, Embase, CINAHL, Cochrane Library, trial registers, and reference lists of relevant articles.
Study Selection And Data Extraction:
Eligible studies included randomized controlled trials of ED-based care transition interventions involving pediatric patients (aged ≤18 years). Study selection, data extraction, and risk of bias assessment were performed in duplicate and independent manner. Study results were pooled for meta-analysis by using a random effects model.
Results:
Sixteen randomized controlled trials, comprising 3760 patients, were included in the study. Most interventions were single-site (n = 14), multicomponent (n = 12), and focused on patients with asthma (n = 8). Pooling data from 10 studies (n = 1965 patients) found moderate-quality evidence for a relative increase of 29% in outpatient follow-up with interventions compared with routine care (odds ratio, 1.58 [95% confidence interval, 1.08-2.31]). Successful interventions included structured telephone reminders, educational counseling on follow-up, and appointment scheduling assistance. There was low-quality evidence when pooling data from 5 studies (n = 1609 participants) that exhibited little or no beneficial effect of interventions on ED readmissions (risk ratio, 1.02 [95% confidence interval, 0.91-1.15]).
Limitations:
All studies were conducted in urban US hospitals which makes generalization of the results to rural settings and other countries difficult.
Conclusions:
ED-based care transition interventions are effective in increasing follow-up but do not seem to reduce ED readmissions. Further research is required to investigate the mechanisms that affect the success of these interventions.
