Jeremy D Meier1, Karen J Valentine2,3, Caroline Hagedorn4, Christine Hartling2, William Gershan4, Harlan R Muntz1, Nancy A Murphy4. 1. Division of Otolaryngology, Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA. 2. Pediatric Specialty Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA. 3. Institute for Health Care Delivery Research, Intermountain Healthcare, Salt Lake City, UT, USA. 4. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
Abstract
PURPOSE: To characterize high emergency department (ED) use by children with tracheostomies and complex chronic conditions, to distinguish avoidable from unavoidable ED visits, and to describe the financial impact of avoidable visits. METHODS: Children with tracheostomies in a pediatric tertiary care center with the highest ED utilization were identified via analysis of administrative data. Six experts in interdisciplinary dyads reviewed the records from all ED visits for these children, and distinguished avoidable from unavoidable visits. Hospital cost data for avoidable visits is described. RESULTS: Among 75 children with tracheostomies and complex chronic conditions, 23 (31%) were high ED utilizers. These 23 children accounted for 74% of all ED discharges the total group of 75 children from 2008 to 2011. Four of these 23 children with high utilization were excluded, leaving 19 subjects for review. These 19 children had 312 ED visits, of which 103 (33%) were deemed avoidable. Leading reasons for avoidable visits were uncomplicated upper respiratory infections, gastrointestinal infections, and enteral feeding system problems. Avoidable visits cost the hospital {$}67,940. CONCLUSIONS: One-third of ED visits by children with tracheostomies and complex chronic conditions may be avoidable. Increased ambulatory access to interdisciplinary teams of providers familiar with these children's unique needs might reduce avoidable ED visits and improve health outcomes. Further studies on how this model of ambulatory care might affect ED utilization and total healthcare costs are needed.
PURPOSE: To characterize high emergency department (ED) use by children with tracheostomies and complex chronic conditions, to distinguish avoidable from unavoidable ED visits, and to describe the financial impact of avoidable visits. METHODS:Children with tracheostomies in a pediatric tertiary care center with the highest ED utilization were identified via analysis of administrative data. Six experts in interdisciplinary dyads reviewed the records from all ED visits for these children, and distinguished avoidable from unavoidable visits. Hospital cost data for avoidable visits is described. RESULTS: Among 75 children with tracheostomies and complex chronic conditions, 23 (31%) were high ED utilizers. These 23 children accounted for 74% of all ED discharges the total group of 75 children from 2008 to 2011. Four of these 23 children with high utilization were excluded, leaving 19 subjects for review. These 19 children had 312 ED visits, of which 103 (33%) were deemed avoidable. Leading reasons for avoidable visits were uncomplicated upper respiratory infections, gastrointestinal infections, and enteral feeding system problems. Avoidable visits cost the hospital {$}67,940. CONCLUSIONS: One-third of ED visits by children with tracheostomies and complex chronic conditions may be avoidable. Increased ambulatory access to interdisciplinary teams of providers familiar with these children's unique needs might reduce avoidable ED visits and improve health outcomes. Further studies on how this model of ambulatory care might affect ED utilization and total healthcare costs are needed.
Authors: Ricardo A Mosquera; Elenir B C Avritscher; Claudia Pedroza; Cynthia S Bell; Cheryl L Samuels; Tomika S Harris; Julie C Eapen; Aravind Yadav; Michelle Poe; Raymond L Parlar-Chun; Jay Berry; Jon E Tyson Journal: JAMA Pediatr Date: 2021-01-04 Impact factor: 16.193
Authors: Anwar E Ahmed; Bashayr I ALMuqbil; Manair N Alrajhi; Hend R Almazroa; Doaa A AlBuraikan; Monirah A Albaijan; Maliha Nasim; Majid A Alsalamah; Donna K McClish; Hamdan Al-Jahdali Journal: BMC Pediatr Date: 2018-06-26 Impact factor: 2.125
Authors: Merel H J Hazewinkel; Remco R Berendsen; Rik C J van Klink; Hans Dik; Jeroen Wink; Jerry Braun; Robert A F de Lind van Wijngaarden Journal: JTCVS Open Date: 2021-08-21