Pediatric Emergency Department Resource Utilization among Children with Primary Care Clinic Contact in the Preceding...

Area of Science:

• Pediatric Healthcare
• Health Services Research
• Emergency Medicine

Background:

• Understanding patient pathways to the emergency department (ED) is crucial for optimizing healthcare resource allocation.
• Primary care clinic interactions preceding an ED visit can influence subsequent healthcare utilization.
• Characterizing these pre-ED contacts can inform strategies to manage patient flow and resource use.

Purpose of the Study:

• To analyze pediatric patient contacts with their primary care clinic within 48 hours before an emergency department (ED) visit.
• To determine how the type of primary care clinic contact influences ED resource utilization and patient disposition.

Main Methods:

• A retrospective chart review was conducted for 368 pediatric ED visits over a 12-month period.
• Inclusion criteria required a preceding contact with the child's general pediatric clinic within the study health system.
• Data on clinic contact type (in-person, phone call during/after hours) and ED resource use (tests, treatments, admission) were analyzed using descriptive statistics and chi-squared tests.

Main Results:

• The majority of ED visits (78.8%) followed a single clinic contact.
• In-person clinic visits with advice to proceed to the ED resulted in significantly higher rates of testing and admission compared to phone contacts or no prior advice.
• Of 474 clinic contacts, 149 were in-person, 216 were phone calls during clinic hours, and 109 were phone calls after hours.

Conclusions:

• In-person primary care visits, particularly when advising an ED visit, are associated with the highest emergency department resource consumption.
• The findings suggest that the modality and advice given during primary care contact significantly impact ED resource use.
• Limitations include the single-health-system scope and lack of a standardized ED triage process across clinics.