From New Hanover Regional Medical Center Residency in Family Medicine, Wilmington, NC (TD, AM, JB, SB).
J Am Board Fam Med. 2018 Jul-Aug;31(4):550-557. doi: 10.3122/jabfm.2018.04.170474.
The goal of this study was to decrease avoidable, low-acuity emergency department (ED) use among pediatric patients at Coastal Family Medicine. The rationale behind this focus was to improve continuity for our patients while decreasing the cost burden for low-acuity ED visits. The family medicine residency clinic pediatric panel has grown by 35% over the past 3 years, bringing this issue of same-day acute access in our clinic to the forefront.
A survey was created to better understand the needs of our high users of the ED. The survey identified that patients believed the ED provided better same-day access than our clinic during the daytime hours, 8 am-5 pm, Monday-Friday. By using this data, along with a literature review and a community practice review, a business-hour walk-in clinic for ages 0 years to 18 years was started to improve access. Clinic posters, revised scripting for office staff, phone room staff, and our after-hour triage line as well as bookmarks advertising the walk-in clinic given during well-child checks were created to address parent education. Pediatric ED data generated through our electronic medical record as well as through Medicaid reimbursement data framed the scope of this issue as significant. This was used to monitor pediatric ED visits following interventions as well.
Over the initial 3 months of interventions, pediatric ED use decreased by 62 visits compared with the prior year. The low-acuity diagnoses of upper respiratory infections decreased by 43.7% (71 to 40 visits) and fever decreased by 50.0% (14 to 7 visits) from the same 3 months the year prior. This decrease was sustained when examined during year 3. Over the next 12 months, there were 284 (29.8%) less visits to the ED with low-acuity diagnoses. This calculates to approximately $300,000 saved to the Medicaid system. During this time frame, our pediatric panel increased by 200 patients.
Increasing access and improving patient education decreased low-acuity pediatric ED visits in our clinic. This combination of interventions worked well in our community and has been shown to help optimize the setting in which pediatric patients are seen.
本研究旨在减少 Coastal Family Medicine 儿科患者中可避免的低 acuity 急诊科（ED）就诊。关注这一问题的理由是提高患者连续性，同时降低低 acuity ED 就诊的成本负担。家庭医学住院医师诊所儿科小组在过去 3 年中增长了 35%，这使得我们诊所当天急性就诊的问题成为了首要问题。
创建了一项调查，以更好地了解 ED 高使用率患者的需求。调查发现，患者认为 ED 在白天（周一至周五上午 8 点至下午 5 点）提供的当天就诊服务比我们诊所更好。通过使用这些数据，以及文献综述和社区实践综述，我们开设了一个工作时间的儿科患者随到随诊诊所，以改善就诊机会。创建了诊所海报、修订了办公室工作人员、电话室工作人员和我们夜间分诊线的脚本，以及在儿童保健检查期间发放的宣传随到随诊诊所的书签，以开展家长教育。通过电子病历和 Medicaid 报销数据生成的儿科 ED 数据表明该问题具有重要意义。这也用于监测干预措施后的儿科 ED 就诊情况。
干预措施实施后的最初 3 个月，儿科 ED 就诊次数减少了 62 次，与前一年相比。上呼吸道感染的低 acuity 诊断减少了 43.7%（71 次就诊减少至 40 次就诊），发热减少了 50.0%（14 次就诊减少至 7 次就诊），而前一年同期这两种疾病的就诊次数都减少了。在第 3 年的检查中，这种减少趋势仍然持续。在接下来的 12 个月中，低 acuity 诊断的 ED 就诊次数减少了 284 次（29.8%），这为 Medicaid 系统节省了约 30 万美元。在此期间，我们的儿科患者小组增加了 200 名患者。
增加就诊机会和改善患者教育降低了我们诊所的低 acuity 儿科 ED 就诊次数。这些干预措施的结合在我们的社区中效果良好，并已被证明有助于优化儿科患者就诊环境。
