Emergency Department-Based Care Transitions for Pediatric Patients: A Systematic Review.

CONTEXT

Successful care transitions between emergency departments (EDs) and outpatient settings have implications for quality, safety, and cost of care.

OBJECTIVE

To investigate the effectiveness of ED-based care transition interventions in achieving outpatient follow-up among pediatric patients.

DATA SOURCES

Medline, Embase, CINAHL, Cochrane Library, trial registers, and reference lists of relevant articles.

STUDY SELECTION AND DATA EXTRACTION

Eligible studies included randomized controlled trials of ED-based care transition interventions involving pediatric patients (aged ≤18 years). Study selection, data extraction, and risk of bias assessment were performed in duplicate and independent manner. Study results were pooled for meta-analysis by using a random effects model.

RESULTS

Sixteen randomized controlled trials, comprising 3760 patients, were included in the study. Most interventions were single-site (n = 14), multicomponent (n = 12), and focused on patients with asthma (n = 8). Pooling data from 10 studies (n = 1965 patients) found moderate-quality evidence for a relative increase of 29% in outpatient follow-up with interventions compared with routine care (odds ratio, 1.58 [95% confidence interval, 1.08-2.31]). Successful interventions included structured telephone reminders, educational counseling on follow-up, and appointment scheduling assistance. There was low-quality evidence when pooling data from 5 studies (n = 1609 participants) that exhibited little or no beneficial effect of interventions on ED readmissions (risk ratio, 1.02 [95% confidence interval, 0.91-1.15]).

LIMITATIONS

All studies were conducted in urban US hospitals which makes generalization of the results to rural settings and other countries difficult.

CONCLUSIONS

ED-based care transition interventions are effective in increasing follow-up but do not seem to reduce ED readmissions. Further research is required to investigate the mechanisms that affect the success of these interventions.