TITLE

Preventing or accelerating emergency care for children with complex healthcare needs

AUTHOR(S)
Sutton, David; Stanley, Paul; Babl, Franz E.; Phillips, Fiona
PUB. DATE
January 2008
SOURCE
Archives of Disease in Childhood;Jan2008, Vol. 93 Issue 1, p17
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objective: A subgroup of children with special health care needs (CSHCN) have chronic and complex medical conditions and frequently attend the emergency department (ED). Some of these ED visits could be prevented through appropriate clinician advice or, if an ED visit is unavoidable, the management time could be decreased. We set out to determine whether an ED-based advice and coordination programme was feasible and could prevent or accelerate ED care for these patients. Methods, setting and patients: We identified CSHCN who frequently attended the ED at a large tertiary children's hospital. These patients were enrolled in an ED- based coordination programme, the Accelerated Care through Emergency (ACE) programme providing 24-hour mobile-phone access to experienced ED nurses. We prospectively tracked usage patterns and determined the rate of ED visits after receiving phone advice and the waiting time for patients to be seen in ED. Parental satisfaction and cost of the programme were also assessed. Results: After a pilot phase in 2002, enrollment in the programme increased from 125 in 2003 to 220 patients in 2006. Patients had a broad range of medical conditions. All had two or more and up to 22 medical services involved in their care. 80% of patients used a technical device or implant. Phone calls increased from an initial average of 31 per month in 2003 (0.24 calls per participant) to 66 per month in 2006 (0.3 calls per participant), 60% of which were after hours. The percentage of ED reviews per phone call dropped from an initial 74.2% (95% Cl 55.2%-88.1%) in 2003 to 50.0% )95% Cl 37.4%-62.5%) in 2006 )p = 0.02). However, decreases in ED visits and admissions as a percentage of enrolled patients and as a percentage of phone calls to ACE staff were not statistically significant. Mean waiting time for enrolled patients remained below 30 minutes. Parent satisfaction with the programme was rated 8.3 on a 0-10 scale (0 meaning poor, 10 meaning excellent). The approximate cost of the programme per child was AU$750 £292) per year. Conclusion: We have developed a coordinated approach towards the provision of healthcare for a group of families with diverse severe chronic medical conditions who frequently present to the ED. Through a comprehensive programme including the development of patient-care plans, care coordination and 24-hour mobile-phone access we were able to enhance families' capacities to manage their children's conditions in the community.
ACCESSION #
31220808

 

Related Articles

  • Children with Special Health Care Needs: National Survey of Prevalence and Health Care Needs. Allen, Patricia L. Jackson // Pediatric Nursing;Jul/Aug2004, Vol. 30 Issue 4, p307 

    The article presents data and findings of survey conducted in the U.S. on the physical and developmental assessment and other topics related to children with special health care needs. The Maternal and Child Health Bureau and the National Center jointly conducted the survey for Health...

  • Specialty services for children with special health care needs: supplement not supplant the medical home. Graham, Robert J. // Archives of Disease in Childhood;Jan2008, Vol. 93 Issue 1, p2 

    The article focuses on the Accelerated Care through Emergency (ACE) program for children with special health care needs (CSHCN). The program was part of the study intended to minimize the use of emergency department (ED) services by CSHCN while improving the delivery of care. Relative to this, a...

  • Do pediatric emergency departments pose a risk of infection? Quach, Caroline; Moore, Dorothy; Ducharme, Francine; Chalut, Dominic // BMC Pediatrics;2011, Vol. 11 Issue 1, p1 

    Background: There is no data documenting the existence of a risk of infection transmission in ambulatory healthcare settings but concern remains. Our objective was to determine the risk of infection associated to a pediatric Emergency Department (ED) visit and the predictors of infection in...

  • The Nation's Readiness for Children in Disasters: What Every Health Professional Needs to Know. Anderson, Michael R. // RT: The Journal for Respiratory Care Practitioners;Jul2010, Vol. 23 Issue 7, p18 

    The article focuses on the medical, social and psychological needs of children in disasters that health professionals should know in the U.S. It discusses the need for medical planners and providers to assess their area's preparedness level for pediatric care. It offers recommendations on how to...

  • Groups Provide Guidance in Transitioning Adolescents from Pediatric to Adult Care.  // American Family Physician;9/15/2011, Vol. 84 Issue 6, p607 

    The article features the guidelines on planning and executing health care transitions for young adult patients and adolescents as developed by the American Academy of Pediatrics (AAP), the American College of Physicians (ACP) and American Academy of Family Physicians (AAFP).

  • Special Care for Our Kids. Weiss, Allen S. // Naples Health;Oct-Dec2015, p4 

    The author discusses the need of expanding in pediatric medical care the U.S. while mentioning shift of nonprofit NCH Healthcare System Pediatric Emergency Department staff to Robert, Mariann and Megan MacDonald Emergency Department.

  • The Top Pediatric Centers. Comarow, Avery // U.S. News Digital Weekly;5/20/2011, Vol. 3 Issue 20, p17 

    The article reports on the top pediatric centers in the U.S. in 2011. It is noted that only about 1 in 30 has deep expertise in caring for children with serious problems out of all the roughly 5,000 hospitals in the country. The top children's hospitals include Children's Hospital Boston and...

  • MEDICATION MANAGEMENT.  // H&HN: Hospitals & Health Networks;May2009, Vol. 83 Issue 5, following p32 

    The article discusses the issue of pediatric medication error in the U.S. The author notes that reducing pediatric medication errors is a priority in the country. An analysis showed that 3.6 percent of medication errors in pediatric patients led to patient harm. Causes of medication errors in...

  • Life-Sustaining Medical Treatment Guidelines.  // American Family Physician;5/1/1994, Vol. 49 Issue 6, p1534 

    Announces that guidelines for physicians who must make decisions regarding life-sustaining medical treatment with pediatric patients have been provided by the American Academy of Pediatrics (AAP). Medical care in conformity with modern medical, ethical and legal norms; Recommendation by the AAP...

Share

Read the Article

Other Topics