The impact of follow-up calls after a pediatric emergency department visit

Pediatric emergency department (ED) visits can be a stressful time for patients and their caregivers. This high stress environment can lead to questions and needed clarifications post-discharge. We implemented a post-discharge callback system to resolve these concerns for a focused subset of patients who historically have provided the most negative comment feedback on ED patient experience surveys. We hypothesized that comment types would shift to more positive than negative and the themes of the comments received would change. We developed a discharge callback process that focused on patients who were triaged as ESI level 4 during their emergency department visit. Over a 6-week period, patients were called the day after discharge and asked if they had questions regarding their recent ED visit in addition to questions regarding current health, post-discharge instructions, prescriptions, or follow-up instructions if applicable. A maximum of 3 discharge calls were made if needed in order to contact the patient or family. Any questions regarding health care needs were followed up by a licensed healthcare provider within 24 hours with a maximum of 3 attempts. At the end of the project timeframe we analyzed comments received from our patient experience surveys to identify if there was a shift in comment types and their themes. In addition, we analyzed ED return rates within 72 hours of discharge. During the 6-week period, 2710 calls were made to contact 1618 patients’ caregivers. Follow up was requested by 149 families with a healthcare provider. There was no significant change in the number of comment types received. Thematic analysis of the patient experience survey comments received during this time period, revealed a reduction in questions regarding the recent ED visit and post discharge needs. There was no significant change in 72-hour ED return rates. The institution of an ED discharge callback system can effectively reduce patients’ and families’ questions regarding post-discharge care by providing an opportunity to clarify care after they have left the emergency department. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Clinical presentation of intoxication due to synthetic cannabinoids.

Synthetic cannabinoids are relatively novel substances of abuse. The use of these compounds among adolescents and young adults has been increasing, making it important for pediatric providers to be familiar with the presenting signs and symptoms of intoxication. We describe three case presentations of reported synthetic cannabinoid intoxication and provide a brief discussion of these compounds.</jats:p

Impact of Universal Suicide Risk Screening in a Pediatric Emergency Department: A Discrete Event Simulation Approach

Objective: The aim of this study was to use discrete event simulation (DES) to model the impact of two universal suicide risk screening scenarios (emergency department [ED] and hospital-wide) on mean length of stay (LOS), wait times, and overflow of our secure patient care unit for patients being evaluated for a behavioral health complaint (BHC) in the ED of a large, academic children\u27s hospital. Methods: We developed a conceptual model of BHC patient flow through the ED, incorporating anticipated system changes with both universal suicide risk screening scenarios. Retrospective site-specific patient tracking data from 2017 were used to generate model parameters and validate model output metrics with a random 50/50 split for derivation and validation data. RESULTS: The model predicted small increases (less than 1 hour) in LOS and wait times for our BHC patients in both universal screening scenarios. However, the days per year in which the ED experienced secure unit overflow increased (existing system: 52.9 days; 95% CI, 51.5-54.3 days; ED: 94.4 days; 95% CI, 92.6-96.2 days; and hospital-wide: 276.9 days; 95% CI, 274.8-279.0 days). Conclusions: The DES model predicted that implementation of either universal suicide risk screening scenario would not severely impact LOS or wait times for BHC patients in our ED. However, universal screening would greatly stress our existing ED capacity to care for BHC patients in secure, dedicated patient areas by creating more overflow

Factors affecting acceptance of routine human immunodeficiency virus screening by adolescents in pediatric emergency departments

Purpose Human immunodeficiency virus (HIV) screening in health care settings including emergency departments (EDs) is recommended for adolescents in the United States. This study aimed to evaluate the acceptance of and the factors affecting the HIV screening in pediatric EDs. Methods A prospective, cross-sectional study of rapid opt-out oral HIV screening among adolescents ≥13 years of age was conducted in two pediatric EDs during 2009-2011. Descriptive statistics and logistic regression models were used to identify factors associated with the acceptance of HIV screening. Results During 24 months, 8,519 adolescents were approached for HIV screening; 6,184 (72.6%) did not opt out, and of those 5,764 (93.2%) were tested for HIV. Most adolescents who accepted testing were black (80.5%), female (57.6%), aged 15-17 years (50.1%), and District of Columbia residents (67.7%), and were accompanied by a guardian (69.1%). Acceptance of HIV screening varied by age, race/ethnicity, and state of residence, with younger (\u3c15 years) (adjusted odds ratio [aOR], 1.67; 95% confidence interval [CI], 1.33-2.09), non-black adolescents (aOR,.88; 95% CI,.77-.99) and non-District of Columbia residents (aOR,.86; 95% CI,.77-.96) being more likely to opt out of testing. Lower odds of opt-out of HIV testing were seen among adolescents with a guardian present (aOR,.42; 95% CI,.34-.53). The reasons for opt-out varied significantly by age and the presence of a guardian. Conclusions The patient\u27s age and the presence of a guardian were significantly associated with adolescents\u27 decision and reasons to opt out of HIV screening in pediatric EDs. Further studies are necessary to evaluate the interventions needed to increase routine ED HIV screening in adolescents. © 2014 Society for Adolescent Health and Medicine. All rights reserved