Increased Continuity of Care Associated with Decreased Hospital Admission and Emergency Department Visits for Pediatric Patients with Asthma in Children’s Hospital, KSMC Riyadh

Objective. To assess the use of health care services by inner-city infants enrolled in an early discharge program who received care in a tertiary care children's hospital primary care clinic. Design. Retrospective cohort study. Setting. Large, metropolitan university hospital and a children's hospital. Patients. Term infants cared for in a single full-term nursery, before and after implementation of a coordinated early discharge program, who received primary care at the children's hospital. Intervention. The coordinated Early Discharge Program was characterized by in-hospital visits by hospitalbased coordinating nurses, home visits by nurses from a home nursing agency, and communication with physicians for necessary adjustments in postdischarge care. Methods. After linking birth hospital records and the children's hospital medical records, a retrospective chart review was performed to obtain maternal demographic information and birth hospital length of stay, as well as the infants' attendance at primary care clinic, immunizations, emergency department visits, and rehospitalization. Main Outcome Measures. Number of primary care visits in the first 3 months of life, completion of one series of immunizations by 3 months of life, and number of emergency department visits and rehospitalization during the first 3 months of life. Results. The early discharge group (n = 253) had a significantly shorter birth hospital length of stay (35 ± 24 hours, mean ± SD) when compared with the control group (n = 212) (52 ± 14 hours). The early discharge group was also younger than the control group at the first primary care visit, with significantly more infants visiting the primary care clinic in the first month of life. There was also a significant difference between the groups in the mean number of emergency department visits (early discharge = .61 visits/patient, control = .79 visits/patient) and the proportion of patients with no emergency department visits during the first 3 months of life (early discharge = 57%, control = 43%). There was no difference between the two groups in the proportion of infants completing one series of immunizations or in the number of infants rehospitalized during the study period. Conclusions. Coordinated early discharge with home nursing visits for inner-city infants may result in earlier use of primary care services. Furthermore, there is a significant decrease in use of the emergency department during the first 3 months of life, and no increase in rehospitalization.

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Mental health-related visits in a pediatric emergency department during the COVID-19 pandemic

International Journal of Emergency Medicine ◽

10.1186/s12245-021-00387-0 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Arnaud Fernandez ◽

Morgane Gindt ◽

Phillipe Babe ◽

Florence Askenazy

Keyword(s):

Mental Health ◽

Emergency Department ◽

Pediatric Emergency ◽

Emergency Department Visits ◽

Pediatric Emergency Department ◽

Children's Hospital ◽

Children’S Hospital ◽

Health Related ◽

The University

AbstractWe aimed to describe the epidemiology of all pediatric emergency department visits (focusing on mental health-related visits versus total visits) at the University Children’s Hospital of Nice (France) from 1 January to 31 December 2020 (year of the COVID-19 pandemic) and to compare it with the earlier 3-year period. The increase in mental health-related visits (44.2%) that we observed, while total visits decreased (30.0%), suggests an impact of the pandemic on children’s and adolescents’ mental health.

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215. Appropriateness and Accuracy of Antimicrobial Prescriptions at Pediatric Emergency Department Discharge

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.259 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S109-S110

Author(s):

Jackelyn lau ◽

Shamim Islam ◽

Emily Polischuk

Keyword(s):

Emergency Department ◽

Pediatric Emergency ◽

Emergency Department Visits ◽

Medical Society ◽

Pediatric Emergency Department ◽

Children's Hospital ◽

Common Diagnosis ◽

Children’S Hospital ◽

Dosing Accuracy ◽

Antimicrobial Prescription

Abstract Background Up to 20% of pediatric emergency department visits result in an antimicrobial prescription. The objective of this study was to evaluate the appropriateness and dosing accuracy of antimicrobial prescriptions given at discharge from an ED of a freestanding children’s hospital. Methods Electronic medical records of patients seen in the ED at Oishei Children’s Hospital from 12 dates (3 in each of 4 seasons) were screened. All patients discharged from the ED with a prescription for an antimicrobial were included. Diagnosis, provider type, antibiotic dose per weight, duration and frequency were recorded. Appropriateness of antibiotic choice and dosing accuracy were assessed using major medical society guidelines, pharmacy references and hospital antibiograms. Antibiotic doses were considered inaccurate if >10% outside of recommended weight-based dose ranges. Results Of a total of 1733 screened patients, 12% (207) were discharged with a systemic antimicrobial prescription. The percentage of visits resulting in an antimicrobial prescription varied by season, and was highest during the winter at 19%. Amoxicillin (33% of all) and oseltamivir (15%) were most frequently prescribed. Overall, 98% of patients were prescribed the appropriate antimicrobial, but only 65% of systemic antimicrobial prescriptions had accurate dosing. Amoxicillin was dosed incorrectly in 32% of prescriptions, Figure 1, specifically being below the high-dose recommended range in 28% of otitis media (OM) and 29% of pneumonia cases. Despite being the most common diagnosis, OM was treated with accurate dosing only 57% of the time, Figure 2. Also, more than 40% of patients with UTI or pneumonia had inaccurate drug dosing. Nurse practitioners (NP) prescribed the most antibiotics. Appropriate prescribing did not vary by provider, but accuracy of dosing did; for example, NP dosing accuracy was 58%, vs. 73% for residents (p < 0.04), Figure 3. Dosing Accuracy of Antimicrobials Dosing Accuracy by Diagnosis Appropriateness and Accuracy by Prescriber Group Conclusion An eighth of pediatric ED visits resulted in an antimicrobial prescription. Inaccurate dosing occurred regularly for common infections; most notably underdosing of amoxicillin for OM and pneumonia. Education and audit related to specific drugs and providers promises to be of high stewardship impact in pediatric EDs. Disclosures All Authors: No reported disclosures

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Emergency department visits by children with and without autism spectrum disorder: An initial comparison evaluating multiple outcome measures at one urban children's hospital

Research in Autism Spectrum Disorders ◽

10.1016/j.rasd.2014.10.005 ◽

2015 ◽

Vol 9 ◽

pp. 144-150 ◽

Cited By ~ 3

Author(s):

Laura Baylot Casey ◽

Robert L. Williamson ◽

Sarah Miller ◽

J. Brian Smith ◽

Kimberly N. Frame ◽

...

Keyword(s):

Autism Spectrum Disorder ◽

Emergency Department ◽

Outcome Measures ◽

Autism Spectrum ◽

Emergency Department Visits ◽

Spectrum Disorder ◽

Children's Hospital ◽

Multiple Outcome ◽

Initial Comparison ◽

Children’S Hospital

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Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.791 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S333-S334

Author(s):

So Lim Kim ◽

Angela Everett ◽

Susan J Rehm ◽

Steven Gordon ◽

Nabin Shrestha

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Hospital Admission ◽

Vascular Access ◽

Antimicrobial Therapy ◽

Cleveland Clinic ◽

Emergency Department Visits ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Ed Visits ◽

Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value < 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P < 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

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Impact of the COVID-19 pandemic on the Emergency Department of a tertiary children’s hospital

Italian Journal of Pediatrics ◽

10.1186/s13052-021-00976-y ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Umberto Raucci ◽

Anna Maria Musolino ◽

Domenico Di Lallo ◽

Simone Piga ◽

Maria Antonietta Barbieri ◽

...

Keyword(s):

Emergency Department ◽

School Closure ◽

Process Step ◽

Lazio Region ◽

Children's Hospital ◽

Number Of Children ◽

Children’S Hospital ◽

Ed Visits ◽

Relative Decline ◽

Tract Infections

Abstract Background Italy was the first country in Europe affected by COVID-19: the emergency started on February 20, 2020, culminating with national lockdown on March 11, which terminated on May 4, 2020. We describe how the pandemic affected Emergency Department (ED) accesses in a tertiary children’s hospital, composed by two different pediatric centers, one located in Rome’s city center and the second, Palidoro (regional COVID-19 center), in its surrounding metropolitan area, both in the Lazio region, analyzing the profile of admitted patients during the pandemic period in terms of their general characteristics (at presentation in the ED’s) and urgent hospitalizations compared to prepandemic period. Methods The study compare the period between the 21st of February and the 30th of April 2020, covering the three phases of the national responses (this period will be referred to as the pandemic period) with the same period of 2019 (prepandemic period). The study analyzes the number of ED visits and urgent hospitalizations and their distribution according to selected characteristics. Results The reduction of ED visits was 56 and 62%, respectively in Rome and Palidoro centers. The higher relative decline was encountered for Diseases of Respiratory System, and for Diseases of the Nervous System and Sense Organs. A doubling of the relative frequency of hospitalizations was observed, going from 14.2 to 24.4% in Rome and from 6.4 to 10.3% in Palidoro. In terms of absolute daily numbers the decrease of urgent hospitalizations was less sharp than ED visits. For pathologies such as peritonitis, tumors or other possible life-treathening conditions we did not observe a significative increase due to delayed access. Conclusions In the pandemic period there was a general reduction in the number of children referred to ED, such reduction was greater in low-acuity levels. The reduction for respiratory tract infections and other communicable diseases during school closure and the national lockdown must make us reflect on the possible impact that these conditions may have on the health system, in particular the ED, at the reopening of schools. The major problem remains the fear for possible diagnostic delays in life-threatening or crippling diseases; our study doesn’t demonstrate an increase in number or significant delay in some serious conditions such as tumors, peritonitis, diabetic ketoacidosis, ileo-colic intussusception and testis/ovary torsion. A continuous, deep re-organizational process step by step of the ED is nececessary in the present and upcoming pandemic situation.

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Measles Exposure Investigation in a Children’s Hospital Emergency Department— Denver Metropolitan Area, Colorado, 2019

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.492 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s18-s19

Author(s):

Ashley Richter

Keyword(s):

Emergency Department ◽

International Travel ◽

Childhood Vaccination ◽

Prevention Measures ◽

Mmr Vaccine ◽

Children's Hospital ◽

Control Intervention ◽

Children’S Hospital ◽

Lost To Follow Up

Background: On December 14, 3 unvaccinated siblings with recent international travel presented to Children’s Hospital Colorado emergency department (CHCO-ED) with fever, rash, conjunctivitis, coryza, and cough. Measles was immediately suspected; respiratory masks were placed on the patients before they entered an airborne isolation room, and public health officials (PH) were promptly notified. Notably, on December 12, 1 ill sibling presented to CHCO-ED with fever only. We conducted an investigation to confirm measles, to determine susceptibility of potentially exposed ED contacts and healthcare workers (HCWs), and to implement infection prevention measures to prevent secondary cases. Methods: Measles was confirmed using polymerase chain reaction testing. Through medical record review and CHCO-ED unit-leader interviews, we identified patients and HCWs in overlapping ED areas with the first sibling, until 2 hours after discharge. Measles susceptibility was assessed through interviews with adults accompanying pediatric patients and HCW immunity record reviews. Potentially exposed persons were classified as immune (≥1 documented measles-mumps-rubella (MMR) vaccination or serologic evidence of immunity), unconfirmed immune (self-reported MMR or childhood vaccination without documentation), or susceptible (no MMR vaccine history or age <12 months). Susceptibility status directed disease control intervention, and contact follow-up was 21 days. Results: On December 14, all 3 siblings (ages 8–11 years) had laboratory-confirmed measles and were hospitalized. CHCO’s rapid isolation of the 3 cases within 5 minutes after presentation to the ED eliminated the need for exposure assessment on the day of hospitalization. However on December 12, the 1 ill sibling potentially exposed 258 ED contacts (90 patients, 168 accompanying adults) and 22 HCWs. The PH department identified 158 immune contacts (61%), 75 unconfirmed immune contacts (29%), and 19 susceptible contacts (8%); 6 contacts (2%) were lost to follow-up. Overall, 15 susceptible contacts received immune globulin (IG) postexposure prophylaxis and 4 contacts were placed on 21-day quarantine. Unconfirmed immune contacts self-monitored for measles symptoms and were contacted weekly by PH for 21 days. Moreover, 20 immune HCWs monitored symptoms daily; 2 susceptible HCWs were placed on 21-day quarantine. No secondary cases were identified. Conclusions: Rapid measles identification and isolation, high levels (90%) of immunity among contacts, prompt administration of IG, and effective collaboration between PH and CHCO prevented transmission.Funding: NoneDisclosures: None

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