scholarly journals Evaluation of compliance with early postbirth follow-up and unnecessary visits to the paediatric emergency department: a prospective observational study at the Lenval Children’s Hospital in Nice

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e056476
Author(s):  
Antoine Tran ◽  
Anne-Laure Hérissé ◽  
Marion Isoardo ◽  
Petri Valo ◽  
Anne-Marie Maillotte ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Care Pathway ◽  
Emergency Department Visits ◽  
Secondary Outcome ◽  
Medical Visit ◽  
Paediatric Emergency Department ◽  
Factors Associated ◽  
Paediatric Emergency

ObjectiveTo evaluate compliance with the French National Authority for Health’s (Haute Autorité de Santé, HAS) postbirth follow-up recommendations for newborns attending our paediatric emergency department (PED) and identify risk factors associated with non-compliance and unnecessary emergency department utilisation.DesignProspective, single centre.SettingFourth biggest PED in France in terms of attendance (CHU-Lenval).Patients280 patients of whom 249 were included in the statistical analysis.Main outcome measuresThe primary outcome of this study was the evaluation of compliance of the care pathway for newborns consulting at the PED with respect to the French postbirth follow-up recommendations. Secondary outcome was the assessment of whether the visit to the PED was justified by means of PED reception software and two postconsultation interviewsResults77.5% (193) of the newborns had non-compliant care pathways and 43% (107) of PED visits were unnecessary. Risk factors associated with a non-compliance regarding the HAS’s postbirth follow-up recommendations were: unnecessary visit to the PED (OR 2.0, 95% CI 1.1 to 3.9), precariousness (OR 2.8, 95% CI 1.4 to 6.2), birth in a public maternity hospital (OR 2.5, 95% CI 1.3 to 4.8) and no information about HAS’s postbirth follow-up recommendations on discharge from maternity ward (OR 11.4, 95% CI 5.8 to 23.3). Risk factors for unnecessary PED visits were: non-compliant care pathway (OR 2.0, 95% CI 1.1 to 3.9) and a first medical visit at a PED (OR 1.8, 95% CI 1.1 to 3.1).ConclusionPostbirth follow-up may lead to decrease unnecessary emergency department visits unnecessary emergency department visits.Trial registration numberThe study bears the clinical trial number NCT02863627.

scholarly journals The COVID‐19 pandemic reduced paediatric emergency department visits but did not significantly increase urgent cases

2021 ◽  
Author(s):  
Nikolas Beck ◽  
Miriam Michel ◽  
Uwe Klingkowski ◽  
Elisabeth Binder ◽  
Klaus Kapelari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Visits ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency

scholarly journals A randomized trial of iPad distraction to reduce children’s pain and distress during intravenous cannulation in the paediatric emergency department

2020 ◽  
Author(s):  
Samina Ali ◽  
Keon Ma ◽  
Nadia Dow ◽  
Ben Vandermeer ◽  
Shannon Scott ◽  
...  
Keyword(s):  
Emergency Department ◽  
Standard Care ◽  
Controlled Trial ◽  
Pain Scale ◽  
Emergency Department Visits ◽  
Child Life ◽  
Topical Anesthetic ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Significant Difference

Abstract Objectives We compared the addition of iPad distraction to standard care, versus standard care alone, to manage the pain and distress of intravenous (IV) cannulation. Methods Eighty-five children aged 6 to 11 years requiring IV cannulation (without child life services present) were recruited for a randomized controlled trial from a paediatric emergency department. Primary outcomes were self-reported pain (Faces Pain Scale-Revised [FPS-R]) and distress (Observational Scale of Behavioral Distress-Revised [OSBD-R]), analyzed with two-sample t-tests, Mann–Whitney U-tests, and regression analysis. Results Forty-two children received iPad distraction and 43 standard care; forty (95%) and 35 (81%) received topical anesthesia, respectively (P=0.09). There was no significant difference in procedural pain using an iPad (median [interquartile range]: 2.0 [0.0, 6.0]) in addition to standard care (2.0 [2.0, 6.0]) (P=0.35). There was no significant change from baseline behavioural distress using an iPad (mean ± SD: 0.53 ± 1.19) in addition to standard care (0.43 ± 1.56) (P=0.44). Less total behavioural distress was associated with having prior emergency department visits (odds ratio [95% confidence interval]: −1.90 [−3.37, −0.43]) or being discharged home (−1.78 [−3.04, −0.52]); prior hospitalization was associated with greater distress (1.29 [0.09, 2.49]). Significantly more parents wished to have the same approach in the future in the iPad arm (41 of 41, 100%) compared to standard care (36 of 42, 86%) (P=0.03). Conclusions iPad distraction during IV cannulation in school-aged children was not associated with less pain or distress than standard care alone. The effects of iPad distraction may have been blunted by topical anesthetic cream usage. Clinical trials registration ClinicalTrials.gov: NCT02326623.

scholarly journals To GP or not to GP: a natural experiment in children triaged to see a GP in a tertiary paediatric emergency department (ED)

2017 ◽  
Vol 27 (7) ◽  
pp. 521-528 ◽  
Author(s):  
Laurie Smith ◽  
Yajur Narang ◽  
Ana Belen Ibarz Pavon ◽  
Karl Edwardson ◽  
Simon Bowers ◽  
...  
Keyword(s):  
Emergency Department ◽  
Natural Experiment ◽  
Care Pathway ◽  
Waiting Times ◽  
Sensitivity Analyses ◽  
Antibiotic Prescribing ◽  
Paediatric Hospital ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
The Impact

ObjectiveTo evaluate the impact of integrating a general practitioner (GP) into a tertiary paediatric emergency department (ED) on admissions, waiting times and antibiotic prescriptions.DesignRetrospective cohort study.SettingAlder Hey Children’s NHS Foundation Trust, a tertiary paediatric hospital in Liverpool, UK.ParticipantsFrom October 2014, a GP was colocated within the ED, from 14:00 to 22:00 hours, 7 days a week. Children triaged green on the Manchester Triage System without any comorbidities were classed as ‘GP appropriate’. The natural experiment compared patients triaged as ‘GP appropriate’ and able to be seen by a GP between 14:00 and 22:00 hours (GP group) to patients triaged as ‘GP appropriate’ seen outside of the hours when a GP was available (ED group). Intention-to-treat (ITT) analysis was used to assess the main outcomes.Results5223 patients were designated as ‘GP appropriate’—18.2% of the total attendances to the ED over the study period. There were 2821 (54%) in the GP group and 2402 (46%) in the ED group. The median duration of stay in the ED was 94 min (IQR 63–141) for the GP group compared with 113 min (IQR 70–167) for the ED group (p<0.0005). Using the ITT analysis equivalent, we demonstrated that the GP group were less likely to: be admitted to hospital (2.2% vs 6.5%, OR 0.32, 95% CI 0.24 to 0.44), wait longer than 4 hours (2.3% vs 5.1%, OR 0.45, 95% CI 0.33 to 0.61) or leave before being seen (3.1% vs 5.7%, OR 0.53, 95% CI 0.41 to 0.70), but more likely to receive antibiotics (26.1% vs 20.5%, OR 1.37, 95% CI 1.10 to 1.56). Sensitivity analyses yielded similar results.ConclusionsIntroducing a GP to a paediatric ED service can significantly reduce waiting times and admissions, but may lead to more antibiotic prescribing. This study demonstrates a novel, potentially more efficient ED care pathway in the current context of rising demand for children’s emergency services.

Comparing resource use between paediatric emergency department visits by triage level

2018 ◽  
pp. emermed-2017-207192
Author(s):  
Margaret E Samuels-Kalow ◽  
Matthew Niedzwiecki ◽  
Ari B Friedman ◽  
Peter E Sokolove ◽  
Renee Y Hsia
Keyword(s):  
Emergency Department ◽  
Resource Use ◽  
Emergency Department Visits ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Triage Level

Factors associated with early neonatal attendance to a paediatric emergency department

2013 ◽  
Vol 99 (3) ◽  
pp. 239-243 ◽  
Author(s):  
C F Flanagan ◽  
M Stewart
Keyword(s):  
Emergency Department ◽  
Demographic Data ◽  
Models Of Care ◽  
Equal Distribution ◽  
Out Of Hours ◽  
Feeding Difficulties ◽  
Paediatric Emergency Department ◽  
Factors Associated ◽  
Paediatric Emergency ◽  
Significant Factors

AimTo examine the demographic and perinatal factors involved in the presentation of newborn babies to a paediatric emergency department (PED) and outcome following attendance.MethodsTerm babies who attended the PED of the Royal Belfast Hospital for Sick Children (RBHSC) in the first 2 weeks of life, during two separate 3-month periods in summer and winter 2010–2011 were identified retrospectively from the PED electronic database. Perinatal and demographic data were also obtained on all babies born in the Royal Jubilee Maternity Hospital (RJMH) during the same time period.ResultsA total of 223 attendances to the PED involving 208 babies were identified with almost equal distribution during summer and winter months. Almost two thirds (n=139, 62%) of babies presented out-of-hours. Over half of babies were self-referred by parent/carer. The most common presentation was feeding difficulty, vomiting or faltering growth, accounting for 36%. Significant factors associated with attendance to PED included birth weight <2500 g, deprivation and postnatal stay more than 2 days. Sixty-one babies (24%) presenting to PED were admitted to hospital. Significant factors for admission included age ≤48 h and presentation during the standard working day. Overall, a third of babies admitted stayed less than 24 h (34%).ConclusionsLarge numbers of babies attend the PED in the first 2 weeks of life, commonly out of hours, from deprived areas and with feeding difficulties. A quarter of babies attending are admitted to hospital, with one-third discharged following an overnight stay. Services should be reevaluated, particularly in this current financial climate, in an attempt to find new models of care for these young babies.

scholarly journals Long-term Emergency Department Visits and Readmissions After Laparoscopic Roux-en-Y Gastric Bypass: a Systematic Review

2021 ◽  
Author(s):  
N. van Olst ◽  
A. S. van Rijswijk ◽  
S. Mikdad ◽  
L. J. Schoonmade ◽  
A. W. van de Laar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Gastric Bypass ◽  
Abdominal Pain ◽  
Emergency Department Visits ◽  
Cochrane Library ◽  
Term Care ◽  
Ed Visits

Abstract Purpose There is considerable evidence on short-term outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB), but data on long-term outcome is scarce, especially on postoperative emergency department (ED) visits and readmissions. We aim to systematically review evidence on the incidence, indications, and risk factors of ED visits and readmissions beyond 30 days after LRYGB. Materials and Methods A systematic search in PubMed, Scopus, Embase.com, Cochrane Library, and PsycINFO was performed. All studies reporting ED visits and readmissions > 30 days after LRYGB, with ≥ 50 patients, were included. PRISMA statement was used and the Newcastle-Ottawa Scale for quality assessment. Results Twenty articles were included. Six studies reported on ED visits (n = 2818) and 19 on readmissions (n = 276,543). The rate of patients with an ED visit within 90 days after surgery ranged from 3.9 to 32.6%. ED visits at 1, 2, and 3 years occurred in 25.6%, 30.0%, and 31.1% of patients. Readmissions within 90 days and at 1-year follow-up ranged from 4.1 to 20.5% and 4.75 to 16.6%, respectively. Readmission was 29% at 2 years and 23.9% at 4.2 years of follow-up. The most common reason for ED visits and readmissions was abdominal pain. Conclusion Emergency department visits and readmissions have been reported in up to almost one in three patients on the long-term after LRYGB. Both are mainly indicated for abdominal pain. The report on indications and risk factors is very concise. A better understanding of ED visits and readmissions after LRYGB is warranted to improve long-term care, in particular for patients with abdominal pains.

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