Meier Jeremy D, Valentine Karen J, Hagedorn Caroline, Hartling Christine, Gershan William, Muntz Harlan R, Murphy Nancy A
Division of Otolaryngology, Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
Pediatric Specialty Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.
J Pediatr Rehabil Med. 2015;8(2):105-11. doi: 10.3233/PRM-150324.
To characterize high emergency department (ED) use by children with tracheostomies and complex chronic conditions, to distinguish avoidable from unavoidable ED visits, and to describe the financial impact of avoidable visits.
Children with tracheostomies in a pediatric tertiary care center with the highest ED utilization were identified via analysis of administrative data. Six experts in interdisciplinary dyads reviewed the records from all ED visits for these children, and distinguished avoidable from unavoidable visits. Hospital cost data for avoidable visits is described.
Among 75 children with tracheostomies and complex chronic conditions, 23 (31%) were high ED utilizers. These 23 children accounted for 74% of all ED discharges the total group of 75 children from 2008 to 2011. Four of these 23 children with high utilization were excluded, leaving 19 subjects for review. These 19 children had 312 ED visits, of which 103 (33%) were deemed avoidable. Leading reasons for avoidable visits were uncomplicated upper respiratory infections, gastrointestinal infections, and enteral feeding system problems. Avoidable visits cost the hospital {$}67,940.
One-third of ED visits by children with tracheostomies and complex chronic conditions may be avoidable. Increased ambulatory access to interdisciplinary teams of providers familiar with these children's unique needs might reduce avoidable ED visits and improve health outcomes. Further studies on how this model of ambulatory care might affect ED utilization and total healthcare costs are needed.
描述气管造口术患儿及复杂慢性病患儿在急诊科（ED）的高就诊率，区分可避免和不可避免的急诊就诊，并描述可避免就诊的经济影响。
通过分析管理数据，确定一家儿科三级护理中心中急诊利用率最高的气管造口术患儿。六名跨学科专家小组审查了这些患儿所有急诊就诊的记录，并区分可避免和不可避免的就诊。描述了可避免就诊的医院成本数据。
在75名气管造口术患儿及复杂慢性病患儿中，23名（31%）为急诊高就诊者。这23名患儿占2008年至2011年75名患儿急诊出院总数的74%。这23名高就诊率患儿中有4名被排除，剩下19名受试者进行审查。这19名患儿有312次急诊就诊，其中103次（33%）被认为是可避免的。可避免就诊的主要原因是单纯性上呼吸道感染、胃肠道感染和肠内喂养系统问题。可避免就诊给医院造成了67,940美元的成本。
气管造口术患儿及复杂慢性病患儿三分之一的急诊就诊可能是可避免的。增加对熟悉这些患儿特殊需求的跨学科医疗团队的门诊服务，可能会减少可避免的急诊就诊并改善健康结局。需要进一步研究这种门诊护理模式如何影响急诊利用率和总体医疗成本。
