Article Text

ED PHONE HOME: A PROSPECTIVE RANDOMIZED INTERVENTION TO DECREASE REPEAT EMERGENCY DEPARTMENT VISITS
  1. A D Racine1,
  2. E M Alderman1,
  3. J R Avner1
  1. 1Pediatrics Department, Albert Einstein College of Medicine, Childrenâs Hospital at Montefiore, Bronx, NY, USA

Abstract

Background In 2005 children under 15 yrs accounted for nearly 24 million emergency department (ED) visits in the U.S., up to one-half of which were for non-urgent conditions.

Objective To test whether a follow-up phone call from the primary care practice (PCP) within 72 hours of an ED visit to counsel families about ED use and primary care availability, would modify subsequent ED use.

Design and Methods A longitudinal prospective randomized intervention of subjects visiting an ED from April-December 2005 who received primary care at one of four PCPs associated with an urban medical center. Subjects received either routine follow-up with their PCP or a follow-up phone call from the PCP within 72 hours of the visit. All subsequent visits occurring within 365 days to PCP, ED, pediatric sub-specialists (PSS) or hospitalizations (HOSP) were recorded. Logistic and OLS regressions estimated unadjusted and adjusted odds ratios and mean number of follow-up visits of various types.

Results 4,246 subjects enrolled and recorded 28,009 follow-up visits during the study. The 50% randomized to the intervention group did not differ from the control subjects by age, race, sex, or payer status. Intervention subjects recorded lower rates of follow-up ED visits (OR 0.88; p<0.001), more PSS visits (OR 1.25; p<0.001) and no difference in HOSP compared to controls. Mean number of follow-up PCP visits did not differ between groups.

Conclusions Follow-up phone calls from the PCP offices to counsel families regarding ED use and primary care availability can successfully modify subsequent care seeking behavior in pediatric patients.

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