2.50
Hdl Handle:
http://hdl.handle.net/10755/157952
Type:
Presentation
Title:
Pediatric Emergency Department Recidivism
Abstract:
Pediatric Emergency Department Recidivism
Conference Sponsor:Western Institute of Nursing
Conference Year:2005
Author:LeDuc, Karen, MS, CPN, CNS
P.I. Institution Name:The Children's Hospital Nursing Education Department
Title:Clinical Nurse Specialist
Co-Authors:Heidi Rosebrook, Michael Rannie
Background: Overcrowding in Emergency Departments (ED) has become a national problem. Increases in patient volume and illness severity are among the factors contributing to this crisis. Of particular interest is a small group of patients who account for a disproportionate number of ED visits and are known as recidivists. According to this year's CDC report, National Ambulatory Medical Care Survey: 2001 Emergency Department Summary, visits to EDs rose 20% over the past decade, while the number of EDs in the nation fell 15% in the same time period. The reason for the large number of return visits has not been established nor has a clear description of this problem been found in the literature. Purpose: The purposes of the study included: 1) Identification of the demographic profile of Emergency Department recidivists; 2) Description of illness patterns, access to care patterns, and diagnostic categories for Emergency Department recidivists; and 3) Identification of strategies to improve the rate of recidivism. Sample: The sample consisted of all children who presented to the Emergency Department during a selected one week time period (non-holiday), N= 932. From this primary sample, a subset of patients who were seen more than once in 48 hours (N=38) were selected for a telephone interview and more in-depth analysis. Methods: Medical record data collection was obtained electronically from the computerized data software currently utilized in this ED. A structured telephone interview was utilized to examine the illness behaviors and the utilization of health care services by recidivists. Analysis: Demographic profiles, illness patterns, health care service utilization patterns, health disparities, and socio-economic characteristics of frequent users of the ED were assessed using descriptive statistics. Multiple regression techniques were utilized to predict recidivists from the three month return sample. Results: Total number of patients seen in the first quarter of 2003 = 9026. Of these patients, 1668 had two or more visits in the preceding three months. The calculated rate of recidivism for this quarter = 18.5%. The rate of recidivism was compared to other children's hospitals that utilized a similar calculation to determine recidivism via a BENCH inquiry. Chart reviews were conducted to identify diagnostic discrepancies. Reasons for return visits were categorized according to: illness related factors, physician related factors, and system related factors (Kelly, et al, 1999). Telephone interviews yielded additional information related to illness patterns, health status, and utilization of health care services. The primary care provider not being available was identified as the most frequent reason for their return visits. Regression techniques provided prediction for recidivists when linked with demographic variables such as age and diagnosis. Nursing Implications: Study findings provide an understanding of illness behavior and the influence of the health care system on an individual's utilization of emergency health care services. Frequent users of the ED appear to have adequate access to health care, therefore greater attention to their unique needs in the emergency and primary care settings will improve their quality of care and reduce ED visits.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePediatric Emergency Department Recidivismen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157952-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Pediatric Emergency Department Recidivism</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">LeDuc, Karen, MS, CPN, CNS</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">The Children's Hospital Nursing Education Department</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Nurse Specialist</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">leduc.karen@tchden.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Heidi Rosebrook, Michael Rannie</td></tr><tr><td colspan="2" class="item-abstract">Background: Overcrowding in Emergency Departments (ED) has become a national problem. Increases in patient volume and illness severity are among the factors contributing to this crisis. Of particular interest is a small group of patients who account for a disproportionate number of ED visits and are known as recidivists. According to this year's CDC report, National Ambulatory Medical Care Survey: 2001 Emergency Department Summary, visits to EDs rose 20% over the past decade, while the number of EDs in the nation fell 15% in the same time period. The reason for the large number of return visits has not been established nor has a clear description of this problem been found in the literature. Purpose: The purposes of the study included: 1) Identification of the demographic profile of Emergency Department recidivists; 2) Description of illness patterns, access to care patterns, and diagnostic categories for Emergency Department recidivists; and 3) Identification of strategies to improve the rate of recidivism. Sample: The sample consisted of all children who presented to the Emergency Department during a selected one week time period (non-holiday), N= 932. From this primary sample, a subset of patients who were seen more than once in 48 hours (N=38) were selected for a telephone interview and more in-depth analysis. Methods: Medical record data collection was obtained electronically from the computerized data software currently utilized in this ED. A structured telephone interview was utilized to examine the illness behaviors and the utilization of health care services by recidivists. Analysis: Demographic profiles, illness patterns, health care service utilization patterns, health disparities, and socio-economic characteristics of frequent users of the ED were assessed using descriptive statistics. Multiple regression techniques were utilized to predict recidivists from the three month return sample. Results: Total number of patients seen in the first quarter of 2003 = 9026. Of these patients, 1668 had two or more visits in the preceding three months. The calculated rate of recidivism for this quarter = 18.5%. The rate of recidivism was compared to other children's hospitals that utilized a similar calculation to determine recidivism via a BENCH inquiry. Chart reviews were conducted to identify diagnostic discrepancies. Reasons for return visits were categorized according to: illness related factors, physician related factors, and system related factors (Kelly, et al, 1999). Telephone interviews yielded additional information related to illness patterns, health status, and utilization of health care services. The primary care provider not being available was identified as the most frequent reason for their return visits. Regression techniques provided prediction for recidivists when linked with demographic variables such as age and diagnosis. Nursing Implications: Study findings provide an understanding of illness behavior and the influence of the health care system on an individual's utilization of emergency health care services. Frequent users of the ED appear to have adequate access to health care, therefore greater attention to their unique needs in the emergency and primary care settings will improve their quality of care and reduce ED visits.</td></tr></table>en_GB
dc.date.available2011-10-26T20:21:49Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:21:49Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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