Low-Resource Emergency Department Visits for Children With Complex Chronic Conditions
Emergency Medical Services; Emergency Service Hospital; Child; Chronic Disease; Hospitalization; Humans; Infant; Retrospective Studies
OBJECTIVE: Reducing emergency department (ED) use in children with complex chronic conditions (CCC) is a national health system priority. Emergency department visits with minimal clinical intervention may be the most avoidable. We assessed characteristics associated with experiencing such a low-resource ED visit among children with a CCC. METHODS: A retrospective study of 271,806 ED visits between 2014 and 2017 among patients with a CCC in the Pediatric Health Information System database was performed. The main outcome was a low-resource ED visit, where no medications, laboratory, procedures, or diagnostic tests were administered and the patient was not admitted to the hospital. χ2 Tests and generalized linear models were used to assess bivariable and multivariable relationships of patients' demographic, clinical, and health service characteristics with the likelihood of a low- versus higher-resource ED visit. RESULTS: Sixteen percent (n = 44,111) of ED visits among children with CCCs were low-resource. In multivariable analysis, the highest odds of experiencing a low- versus higher-resource ED visit occurred in patients aged 0 year (vs 16+ years; odds ratio [OR], 3.9 [95% confidence interval {CI}, 3.7-4.1]), living <5 (vs 20+) miles from the ED (OR, 1.7 [95% CI, 1.7-1.8]), and who presented to the ED in the day and evening versus overnight (1.5 [95% CI, 1.4-1.5]). CONCLUSIONS: Infant age, living close to the ED, and day/evening-time visits were associated with the greatest likelihood of experiencing a low-resource ED visit in children with CCCs. Further investigation is needed to assess key drivers for ED use in these children and identify opportunities for diversion of ED care to outpatient and community settings.
Pulcini CD; Coller RJ; Macy ML; Alpern E; Harris D; Rodean J; Hall M; Chung PJ; Berry JG
Pediatric Emergency Care
2022
<a href="http://doi.org/10.1097/pec.0000000000002437" target="_blank" rel="noreferrer noopener">10.1097/pec.0000000000002437</a>
A longitudinal method of teaching pediatric palliative care to interns: preliminary findings regarding changes in interns' comfort level
Female; Humans; Male; Young Adult; Adult; Attitude of Health Personnel; Questionnaires; Attitude to Death; Professional-Family Relations; Longitudinal Studies; Internship and Residency; Professional-Patient Relations; Professional Competence; Pediatrics/education; Palliative Care/methods; Curriculum/standards; Documentation/standards; Teaching/methods
OBJECTIVE: A longitudinal pediatric palliative care curriculum was introduced into the pediatric residency program at the University of California, Los Angeles. The present study explores the possible effects of this curriculum on the interns' self-assessed comfort levels regarding caring for children with life-threatening conditions. METHODS: A newly created assessment tool was administered to interns in order to rate their comfort regarding pediatric palliative care at the beginning and conclusion of their intern year. RESULTS: Twenty-two of the 29 interns completed this survey. Baseline data indicated 55% of the interns had some experience with taking care of a dying pediatric patient during their medical school training, and 79% indicated that they had taken care of a dying adult. Only 7% of the interns felt adequately prepared to deal with death and dying, but all interns indicated interest in further learning about pediatric palliative care. Comparison of the overall comfort levels of the 22 responding residents before and after the first year of training in 20 different related tasks demonstrated a significant self-assessed improvement of comfort in seven areas. There was no increase in self-reported comfort in communication related to palliative care. SIGNIFICANCE OF RESULTS: Residents indicated increased comfort in some areas of pediatric palliative care after the first year of their training. The underlying cause of this increased comfort is unclear at this time. The overall effect of longitudinal palliative care curricula on residents' level of comfort in caring for this population deserves further assessment.
2010
Yazdani S; Evan E; Roubinov D; Chung PJ; Zeltzer L
Palliative & Supportive Care
2010
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Journal Article
<a href="http://doi.org/10.1017/S147895150999068X" target="_blank" rel="noreferrer">10.1017/S147895150999068X</a>