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Research ArticleOriginal Research

Decreasing Low Acuity Pediatric Emergency Room Visits with Increased Clinic Access and Improved Parent Education

Toren Davis, Albert Meyer, Janalynn Beste and Sonali Batish
The Journal of the American Board of Family Medicine July 2018, 31 (4) 550-557; DOI: https://doi.org/10.3122/jabfm.2018.04.170474
Toren Davis
New Hanover Regional Medical Center Residency in Family Medicine, Wilmington, NC (TD, AM, JB, SB).
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Albert Meyer
New Hanover Regional Medical Center Residency in Family Medicine, Wilmington, NC (TD, AM, JB, SB).
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Janalynn Beste
New Hanover Regional Medical Center Residency in Family Medicine, Wilmington, NC (TD, AM, JB, SB).
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Sonali Batish
New Hanover Regional Medical Center Residency in Family Medicine, Wilmington, NC (TD, AM, JB, SB).
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    Figure 1.

    Time line map of interventions, with associated change in pediatric emergency department (ED) visit volume. Postintervention data show a decrease in total ED visits below that of preintervention at approximately the same time interventions started.

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    Figure 2.

    Emergency department (ED) visit acuity before and after interventions. Low acuity level 3 (urgent) saw a statistically significant decrease from 2015 to 2016 and maintained the decrease into 2017. Level 4 (less urgent) saw a decrease that continued in 2017 but was not statistically significant. Emergent (level 2) visits were unchanged throughout. Emergency Severity Index Scale used for acuity scoring (1, immediate; 2, emergent; 3, urgent; 4, less urgent; 5, not urgent) designated level 3 to 5 as low acuity.

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    Figure 3.

    Pediatric emergency department (ED) visits from the year before interventions and after interventions. Pediatric walk-in clinic use is also depicted here with the blue line. The ED use numbers were lower than the year prior for every month since starting our changes, while the walk-in clinic use continues to increase.

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    Figure 4.

    Shifts in patients seen in the emergency department (ED) versus the clinic before interventions (2015) and after interventions (2017). Upper respiratory infections went from 47.5% seen in the clinic to 78.2% in 2017. This was statistically significant (P < .0001). Both fever and otitis media showed similar changes, but the small sample size made them not statistically significant (fever, P = .078).

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    Table 1.

    Questionnaire with Responses for High-Use Emergency Department Pediatric Patients

    Questionn (%); ResponseTotal Responses
    1. Were you discharged home from the emergency room?25 (100); Yes25
    2. Were you aware of the Coastal Family Medicine on-call line?5 (20); Yes25
    3. If yes, did you call the Coastal Family Medicine on-call line?1 (4); Yes25
    4. If during business hours, did you attempt to call the clinic for an acute appointment?3 (12); Yes25
    5. If you used the emergency department, why did you choose that over Coastal Family Medicine?10 (40); emergency department easier than using clinic.25
    12 (48); were not aware of outpatient acute services.
    3 (12); did not think the clinic could handle the child's issue.
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The Journal of the American Board of Family     Medicine: 31 (4)
The Journal of the American Board of Family Medicine
Vol. 31, Issue 4
July-August 2018
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Decreasing Low Acuity Pediatric Emergency Room Visits with Increased Clinic Access and Improved Parent Education
Toren Davis, Albert Meyer, Janalynn Beste, Sonali Batish
The Journal of the American Board of Family Medicine Jul 2018, 31 (4) 550-557; DOI: 10.3122/jabfm.2018.04.170474

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Decreasing Low Acuity Pediatric Emergency Room Visits with Increased Clinic Access and Improved Parent Education
Toren Davis, Albert Meyer, Janalynn Beste, Sonali Batish
The Journal of the American Board of Family Medicine Jul 2018, 31 (4) 550-557; DOI: 10.3122/jabfm.2018.04.170474
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Keywords

  • Ambulatory Care Facilities
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  • Family Medicine
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  • Pediatrics
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