June 13, 2016
By Megan Brooks
NEW YORK (Reuters Health) - A quality-improvement initiative launched in 2013 appears to have reduced avoidable emergency department (ED) visits by pediatric gastroenterology patients, researchers report.
"As part of this project, pediatric gastroenterologists began receiving reports with rates of ED utilization by their patients. The reports generated discussion and a cultural shift and process change in which patients with urgent complaints were treated preferentially in the outpatient office instead of the ED," Dr. Jarone Lee of Massachusetts General Hospital in Boston and colleagues explain in their paper, online June 10 in Pediatrics.
They report that the rate of GI-related ED visits fell by 60% after the intervention, from 4.89 to 1.95 per 1,000 office visits (p<0.001). This translates into roughly 20 fewer ED visits monthly.
In addition, rates of GI-related ED visits during office hours fell 59%, from 2.19 to 0.89 per 1,000 (p<0.001), which represents a decrease of about nine ED visits monthly.
Limitations of the analysis include its retrospective design using hospital data from a single tertiary academic urban center. Also, there could also be "epiphenomena that affected the rate of ED utilization by this population. However, during the study period, there were no major changes in patient population, physician staffing, referral patterns, or processes in the pediatric gastroenterology practice," the researchers note in their paper.
ED use is a major driver of health care costs, they point out, and specialists have a key role in addressing ED utilization.
"I believe that our intervention can be used at any hospital system that has the dedicated resources and databases to support it," Dr. Lee told Reuters Health by email.
"Our project was a simple, low-cost, intervention that allowed us physicians to provide improved and more-efficient care to our patients. In terms of implementation, it does take time. The reports were straightforward to build, but to gain buy-in from the physicians, that took focused time and effort. As a result, for a project like this to work, I believe that the project would need dedicated resources," he noted.
Dr. Lee added, "Overall, the project was well received and has been expanded to many other divisions within Pediatrics. Similarly, we have expanded to many adult medicine divisions within the Department of Medicine. In total, we are currently working with five divisions within the Department of Pediatrics, and six divisions within the Department of Medicine. We also have approached the surgical specialties and plan to work with them in the near future."
The study had no external funding.
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