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Disposition and Follow-up for Low-Risk Febrile Infants: A Secondary Analysis of a Multicenter Study
Nirupama Kannikeswaran1,2, Priya Spencer2, Natalie J Tedford3
1Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, Michigan.
Insights
Most febrile infants have a documented primary care provider (PCP), but less than half have a documented 24-hour follow-up plan after emergency department (ED) discharge. Improving post-ED care plans is crucial for patient safety.
Area of Science:
- Pediatrics
- Emergency Medicine
- Health Informatics
Background:
- American Academy of Pediatrics guidelines suggest discharging low-risk febrile infants from the emergency department (ED) if primary care provider (PCP) follow-up is within 24 hours.
- Assessing the documentation of PCP and follow-up plans is essential for ensuring safe transitions of care.
Purpose of the Study:
- To evaluate the association between electronic health record (EHR) documentation of a PCP and ED disposition for febrile infants.
- To describe the documentation of discharge barriers and post-discharge follow-up plans for low-risk febrile infants.
Main Methods:
- Secondary analysis of a multicenter, cross-sectional study involving low-risk febrile infants.
- Descriptive statistics were used to analyze ED disposition, PCP documentation, follow-up scheduling, and documented barriers to discharge.
Main Results:
- Most infants (90.5%) had EHR documentation of a PCP, with similar proportions in both discharged and hospitalized groups.
- Only 46.0% of infants discharged from the ED had documentation of scheduled or recommended 24-hour PCP follow-up.
- Weekday ED visits were associated with higher rates of documented 24-hour PCP follow-up compared to weekend visits.
Conclusions:
- While most low-risk febrile infants have a documented PCP, a significant gap exists in documenting planned 24-hour follow-up.
- Enhancing the focus on safe, patient-centered post-ED care plans can improve the quality of care for febrile infants.
Objective:
American Academy of Pediatrics guidelines recommend that febrile infants at low risk for invasive bacterial infection be discharged from the emergency department (ED) if primary care provider (PCP) follow-up occurs within 24 hours. We aimed to (1) assess the association between having electronic health record (EHR) documentation of a PCP and ED disposition and (2) describe documentation of potential barriers to discharge and plans for post-discharge follow-up in low-risk febrile infants.
Methods:
We conducted a secondary analysis of a multicenter, cross-sectional study of low-risk febrile infants. Descriptive statistics characterized ED disposition on the basis of the day of the visit, EHR documentation of PCP, scheduled or recommended PCP follow-up, and barriers to discharge.
Results:
Most infants (3565/4042, 90.5%) had EHR documentation of a PCP. Compared with discharged infants, a similar proportion of hospitalized infants had EHR documentation of PCP (90.3% vs 91.2%, P = .47). Few infants (1.5%) had barriers to discharge documented. Of the 3360 infants (83.1%) discharged from the ED, 1544 (46.0%) had documentation of scheduled or recommended 24-hour PCP follow-up. Discharged infants with weekday visits were more likely than those with weekend visits to have documentation of scheduled or recommended 24-hour follow-up (50.0% vs 35.5%, P < .001).
Conclusions:
Most infants had a documented PCP, yet fewer than half had documentation of a scheduled or recommended 24-hour follow-up. A dedicated focus on determining post-ED care plans that are safe and patient-centered may improve the quality of care for this population.
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