Communication Between Primary Care Pediatricians and the Pediatric Emergency Department

Aims: Pediatric emergency department (ED) overcrowding is a challenge. This study was designed to evaluate if a hospital-integrated primary care unit (HPCU) reduces less urgent visits at a pediatric ED. Methods: This retrospective cross-sectional study was carried out at a university hospital in Sweden, where the HPCU, open outside office hours, had been integrated next to the ED. Children seeking ED care during 4-week high- and low-load study periods before (2012) and after (2015) implementation of the HPCU were included. Information on patient characteristics, ED management, and length of ED stay was obtained from hospital data registers. Results: In total, 3216 and 3074 ED patient visits were recorded in 2012 and 2015, respectively. During opening hours of the HPCU, the proportions of pediatric ED visits (28% lower; P < .001), visits in the lowest triage group (36% lower; P < .001), patients presenting with fever ( P = .001) or ear pain ( P < .001), and nonadmitted ED patients ( P = .033), were significantly lower in 2015 than in 2012, whereas the proportion of infants ≤3 months was higher in 2015 ( P < .001). Conclusions: By enabling adjacent management of less urgent pediatric patients at adequate lower levels of medical care, implementation of a HPCU outside office hours may contribute to fewer and more appropriate pediatric ED visits.

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Presentation to Either the Pediatric Emergency Department or Primary Care Clinic for Acute Illness

Pediatric Emergency Care ◽

10.1097/pec.0000000000000082 ◽

2014 ◽

Vol 30 (3) ◽

pp. 146-150 ◽

Cited By ~ 6

Author(s):

Natalie Nokoff ◽

Andrew M. Brunner ◽

James G. Linakis ◽

Siraj Amanullah

Keyword(s):

Primary Care ◽

Emergency Department ◽

Primary Care Clinic ◽

Pediatric Emergency ◽

Acute Illness ◽

Pediatric Emergency Department ◽

Care Clinic

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Guideline Adherence and Antibiotic Utilization by Community Pediatricians, Private Urgent Care Centers, and a Pediatric Emergency Department

Clinical Pediatrics ◽

10.1177/0009922819879462 ◽

2019 ◽

Vol 59 (1) ◽

pp. 21-30 ◽

Cited By ~ 1

Author(s):

Shamim Islam ◽

Mary Kathryn Mannix ◽

Ryan K. Breuer ◽

Amanda B. Hassinger

Keyword(s):

Primary Care ◽

Emergency Department ◽

New York ◽

Otitis Media ◽

Pediatric Emergency ◽

Urgent Care ◽

Medical Society ◽

Pediatric Emergency Department ◽

Antibiotic Utilization ◽

Urgent Care Centers

Pediatric antibiotic prescriptions originate from an increasingly broad range of ambulatory settings. In this retrospective study, pharyngitis, otitis media, sinusitis, pneumonia, and upper respiratory infection cases, at 11 primary care offices, 2 independent urgent care centers (UCCs), and a pediatric emergency department in Western New York, were analyzed relative to medical society practice guidelines and antibiotic utilization. Of 2358 eligible visits across all sites, 25% were for study diagnoses, with 38% at UCC ( P < .01). Across all sites, 26% of pharyngitis cases given antibiotics did not have diagnostic evidence of bacterial infection. At primary care offices and UCCs, guideline recommended first-line agents for pharyngitis and otitis media were used in only 58% and 63% of treated cases, respectively. Overall, an estimated 9855 to 12 045 avoidable antibiotic and 8030 non-guideline antibiotic courses annually are represented by the 14 sites studied. These and other study findings highlight numerous opportunities for outpatient pediatric antibiotic stewardship.

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Is Continuity of Care Preserved in Children Who Utilize the Pediatric Emergency Department?

PEDIATRICS ◽

10.1542/peds.95.1.37 ◽

1995 ◽

Vol 95 (1) ◽

pp. 37-41

Author(s):

Patrick M. Vivier ◽

William J. Lewander ◽

Stanley H. Block ◽

Peter R. Simon ◽

Anthony J. Alario ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Inner City ◽

Health Center ◽

Continuity Of Care ◽

Pediatric Emergency ◽

Health Centers ◽

Pediatric Emergency Department ◽

Primary Care Site

Objective. Inner city families often use multiple sites for nonemergent medical care, including the pediatric emergency department. This practice raises concerns about continuity of care. The present study examined one aspect of continuity of care: Do children who receive care in a pediatric emergency department return to their primary care site so that appropriate follow up may be obtained? Methods. Over a 4-week period two groups of neighborhood health center children were studied: Those who sought care at the pediatric emergency department and those who were "walk-ins" at the health centers. All visits during the 4-week study period which resulted in a recommendation for the child to be seen within 6 weeks at the health centers were included in the analysis. Results. During the study period there were 87 patient visits to the pediatric emergency department with a documented physician instruction to be seen at their health center within 6 weeks. In 66 (76%) of the cases, the patient was seen at one of the health centers during the 6 weeks following the pediatric emergency department visit. There were 146 "walk-in" visits to the health centers with a documented physician instruction to be seen again at the health centers during the 6 weeks following the walk-in visit. In 111 (76%) of the cases, the patient was seen during the 6-week period. Conclusion. Our study shows that revisit rates were comparable for the two groups. We conclude that the rate of compliance with follow-up recommendations is similar for those who utilized the pediatric emergency department versus those who used the primary care site.

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