Sansanee Craig1,2, Irit R Rasooly1,2,3, Andrew S Kern-Goldberger3, Brooke Luo1,2,3, Mark V Mai1,4, Jonathan M Beus1,3,5,6, J Grey Faulkenberry1,3, Canita Brent3, Daniel Herchline3,7,8, Naveen Muthu1,2,3, Christopher P Bonafide1,2,3. 1. Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Pennsylvania. 2. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 3. Section of Hospital Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 4. Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 5. Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia. 6. Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. 7. Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 8. Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.
Abstract
BACKGROUND AND OBJECTIVES: Consumer home monitors (CHM), which measure vital signs, are popular products marketed to detect airway obstruction and arrhythmia. Yet, they lack evidence of infant death prevention, demonstrate suboptimal accuracy, and may result in false alarms that prompt unnecessary acute care visits. To better understand the hospital utilization and costs of CHM, we characterized emergency department (ED) and hospital encounters associated with CHM use at a children's hospital. METHODS: We used structured query language to search the free text of all ED and admission notes between January 2013 and December 2019 to identify clinical documentation discussing CHM use. Two physicians independently reviewed the presence of CHM use and categorized encounter characteristics. RESULTS: Evidence of CHM use contributed to the presentation of 36 encounters in a sample of over 300 000 encounters, with nearly half occurring in 2019. The leading discharge diagnoses were viral infection (13, 36%), gastroesophageal reflux (8, 22%) and false positive alarm (6, 17%). Median encounter duration was 20 hours (interquartile range: 3 hours to 2 days; max 10.5 days) and median cost of encounters was $2188 (interquartile range: $255 to $7632; max $84 928). CONCLUSIONS: Although the annual rate of CHM-related encounters was low and did not indicate a major public health burden, for individual families who present to the ED or hospital for concerns related to CHMs, there may be important adverse financial and emotional consequences.
BACKGROUND AND OBJECTIVES: Consumer home monitors (CHM), which measure vital signs, are popular products marketed to detect airway obstruction and arrhythmia. Yet, they lack evidence of infant death prevention, demonstrate suboptimal accuracy, and may result in false alarms that prompt unnecessary acute care visits. To better understand the hospital utilization and costs of CHM, we characterized emergency department (ED) and hospital encounters associated with CHM use at a children's hospital. METHODS: We used structured query language to search the free text of all ED and admission notes between January 2013 and December 2019 to identify clinical documentation discussing CHM use. Two physicians independently reviewed the presence of CHM use and categorized encounter characteristics. RESULTS: Evidence of CHM use contributed to the presentation of 36 encounters in a sample of over 300 000 encounters, with nearly half occurring in 2019. The leading discharge diagnoses were viral infection (13, 36%), gastroesophageal reflux (8, 22%) and false positive alarm (6, 17%). Median encounter duration was 20 hours (interquartile range: 3 hours to 2 days; max 10.5 days) and median cost of encounters was $2188 (interquartile range: $255 to $7632; max $84 928). CONCLUSIONS: Although the annual rate of CHM-related encounters was low and did not indicate a major public health burden, for individual families who present to the ED or hospital for concerns related to CHMs, there may be important adverse financial and emotional consequences.
Authors: Christopher P Bonafide; A Russell Localio; Daria F Ferro; Evan W Orenstein; David T Jamison; Chris Lavanchy; Elizabeth E Foglia Journal: JAMA Date: 2018-08-21 Impact factor: 56.272