Preventing or accelerating emergency care for children with complex healthcare needs.

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dc.contributor.authorSutton, David
dc.contributor.authorStanley, Paul
dc.contributor.authorBabl, Franz E
dc.contributor.authorPhillips, Fiona
dc.date.accessioned2020-02-06T17:57:14Z
dc.date.available2020-02-06T17:57:14Z
dc.date.issued2007-12-24
dc.description.abstractOBJECTIVE A subgroup of children with special health care needs CSHCN have chronic and complex medical conditions and frequently attend the emergency department ED Some of these ED visits could be prevented through appropriate clinician advice or if an ED visit is unavoidable the management time could be decreased We set out to determine whether an ED based advice and coordination programme was feasible and could prevent or accelerate ED care for these patients METHODS SETTING AND PATIENTS We identified CSHCN who frequently attended the ED at a large tertiary children s hospital These patients were enrolled in an ED based coordination programme the Accelerated Care through Emergency ACE programme providing 24 hour mobile phone access to experienced ED nurses We prospectively tracked usage patterns and determined the rate of ED visits after receiving phone advice and the waiting time for patients to be seen in ED Parental satisfaction and cost of the programme were also assessed RESULTS After a pilot phase in 2002 enrollment in the programme increased from 125 in 2003 to 220 patients in 2006 Patients had a broad range of medical conditions All had two or more and up to 22 medical services involved in their care 80 of patients used a technical device or implant Phone calls increased from an initial average of 31 per month in 2003 0 24 calls per participant to 66 per month in 2006 0 3 calls per participant 60 of which were after hours The percentage of ED reviews per phone call dropped from an initial 74 2 95 CI 55 2 88 1 in 2003 to 50 0 95 CI 37 4 62 5 in 2006 p 0 02 However decreases in ED visits and admissions as a percentage of enrolled patients and as a percentage of phone calls to ACE staff were not statistically significant Mean waiting time for enrolled patients remained below 30 minutes Parent satisfaction with the programme was rated 8 3 on a 0 10 scale 0 meaning poor 10 meaning excellent The approximate cost of the programme per child was AU 750 292 pounds sterling per year CONCLUSION We have developed a coordinated approach towards the provision of healthcare for a group of families with diverse severe chronic medical conditions who frequently present to the ED Through a comprehensive programme including the development of patient care plans care coordination and 24 hour mobile phone access we were able to enhance families capacities to manage their children s conditions in the community
dc.identifier.urihttp://dx.doi.org/10.1136/adc.2007.117960
dc.identifier.urihttps://lib.digitalsquare.io/xmlui/handle/123456789/5835
dc.relation.uriArchives of disease in childhood
dc.subjectClient
dc.subjectChild
dc.subjectAt risk for a particular disease or infection
dc.subjectAcceptability
dc.subjectTimeliness of care
dc.subjectUnnecessary referrals and transportation
dc.subjectPlanning and coordination
dc.subjectEfficiency
dc.subjectPrototype
dc.subjectChild Health
dc.subjectAcute or emergency
dc.subjectPreventive
dc.subjectHealth education or promotion
dc.subjectHotlines and information services
dc.subjectVoice
dc.subjectAudio
dc.titlePreventing or accelerating emergency care for children with complex healthcare needs.en
dcterms.abstractOBJECTIVE A subgroup of children with special health care needs CSHCN have chronic and complex medical conditions and frequently attend the emergency department ED Some of these ED visits could be prevented through appropriate clinician advice or if an ED visit is unavoidable the management time could be decreased We set out to determine whether an ED based advice and coordination programme was feasible and could prevent or accelerate ED care for these patients METHODS SETTING AND PATIENTS We identified CSHCN who frequently attended the ED at a large tertiary children s hospital These patients were enrolled in an ED based coordination programme the Accelerated Care through Emergency ACE programme providing 24 hour mobile phone access to experienced ED nurses We prospectively tracked usage patterns and determined the rate of ED visits after receiving phone advice and the waiting time for patients to be seen in ED Parental satisfaction and cost of the programme were also assessed RESULTS After a pilot phase in 2002 enrollment in the programme increased from 125 in 2003 to 220 patients in 2006 Patients had a broad range of medical conditions All had two or more and up to 22 medical services involved in their care 80 of patients used a technical device or implant Phone calls increased from an initial average of 31 per month in 2003 0 24 calls per participant to 66 per month in 2006 0 3 calls per participant 60 of which were after hours The percentage of ED reviews per phone call dropped from an initial 74 2 95 CI 55 2 88 1 in 2003 to 50 0 95 CI 37 4 62 5 in 2006 p 0 02 However decreases in ED visits and admissions as a percentage of enrolled patients and as a percentage of phone calls to ACE staff were not statistically significant Mean waiting time for enrolled patients remained below 30 minutes Parent satisfaction with the programme was rated 8 3 on a 0 10 scale 0 meaning poor 10 meaning excellent The approximate cost of the programme per child was AU 750 292 pounds sterling per year CONCLUSION We have developed a coordinated approach towards the provision of healthcare for a group of families with diverse severe chronic medical conditions who frequently present to the ED Through a comprehensive programme including the development of patient care plans care coordination and 24 hour mobile phone access we were able to enhance families capacities to manage their children s conditions in the community
dcterms.contributorSutton, David
dcterms.contributorStanley, Paul
dcterms.contributorBabl, Franz E
dcterms.contributorPhillips, Fiona
dcterms.identifierhttp://dx.doi.org/10.1136/adc.2007.117960
dcterms.relationArchives of disease in childhood
dcterms.subjectClient
dcterms.subjectChild
dcterms.subjectAt risk for a particular disease or infection
dcterms.subjectAcceptability
dcterms.subjectTimeliness of care
dcterms.subjectUnnecessary referrals and transportation
dcterms.subjectPlanning and coordination
dcterms.subjectEfficiency
dcterms.subjectPrototype
dcterms.subjectChild Health
dcterms.subjectAcute or emergency
dcterms.subjectPreventive
dcterms.subjectHealth education or promotion
dcterms.subjectHotlines and information services
dcterms.subjectVoice
dcterms.subjectAudio
dcterms.titlePreventing or accelerating emergency care for children with complex healthcare needs.en
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