Tran Quincy Khoi, Bayram Jamil D, Boonyasai Romsai T, Case Meredith A, Connor Christine, Doggett David, Fawole Oluwakemi A, Ijagbemi O Mayowa, Levin Scott, Wu Albert W, Pham Julius Cuong
From the *Department of Emergency Medicine, Division of Critical Care, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine; †Department of Emergency Medicine, Johns Hopkins University School of Medicine, and ‡Division of General Internal Medicine, Armstrong Institute for Patient Safety and Quality, Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins University School of Medicine, Baltimore, MD; §Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; ∥Department of Emergency Medicine, Johns Hopkins Health System; ¶Evidence-Based Practice Center, Johns Hopkins University; #Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine; **Department of Emergency Medicine, Johns Hopkins University School of Medicine, ††Department of Applied Mathematics, Johns Hopkins University Whiting School of Engineering; ‡‡Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine; and §§Department of Emergency Medicine, Anesthesia Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.
Pediatr Emerg Care. 2016 Aug;32(8):570-7. doi: 10.1097/PEC.0000000000000876.
Children discharged from emergency departments (EDs) are often at risk for ED return. The objective was to identify risk factors and interventions to mitigate or prevent ED return among this patient population.
Structured literature review of PubMed and clinicaltrials.gov was conducted to identify relevant studies. Inclusion criteria were studies evaluating ED returns by identifying risk factors and interventions in the pediatric population. Emergency department return was defined as returning to the ED within 1 year after initial visit. Abstract and full text articles were reviewed, and data were abstracted by 2 independent authors.
A total of 963 articles were screened and yielded 42 potential relevant articles involving pediatric population. After full text review, a total of 12 articles were included in the final analysis (6 on risk factors and 6 on interventions). Risk factors for pediatric ED return included behavioral/psychiatric problems, younger age, acuity of illness, medical history of asthma, and social factors. Interventions included computer-generated instructions, postdischarge telephone coaching, ED-made appointments, case management, and home environment intervention. Emergency department-made appointments and postdischarge telephone coaching plus monetary incentive improved outpatient follow-up rate but not ED return. Home environment assessment coupled with case management reduced ED returns specifically among asthma patients.
Several patient and visit characteristics can help predict children at risk for ED return. Although some interventions are successful at improving postdischarge follow-up, most did not reduce ED returns.
从急诊科出院的儿童常常有返回急诊科的风险。目的是确定风险因素以及减轻或预防该患者群体返回急诊科的干预措施。
对PubMed和clinicaltrials.gov进行结构化文献回顾以确定相关研究。纳入标准为通过识别儿科人群中的风险因素和干预措施来评估急诊科返回情况的研究。急诊科返回定义为初次就诊后1年内返回急诊科。对摘要和全文文章进行了审查，数据由2名独立作者提取。
共筛选了963篇文章，产生了42篇涉及儿科人群的潜在相关文章。经过全文审查，最终分析共纳入12篇文章（6篇关于风险因素，6篇关于干预措施）。儿科急诊科返回的风险因素包括行为/精神问题、年龄较小、疾病严重程度、哮喘病史和社会因素。干预措施包括计算机生成的指导、出院后电话指导、急诊科预约、病例管理和家庭环境干预。急诊科预约以及出院后电话指导加金钱激励提高了门诊随访率，但未降低急诊科返回率。家庭环境评估与病例管理相结合，特别是在哮喘患者中降低了急诊科返回率。
若干患者和就诊特征有助于预测有返回急诊科风险的儿童。尽管一些干预措施在改善出院后随访方面取得了成功，但大多数并未降低急诊科返回率。
