Key result
ED-based care transition interventions increased outpatient follow-up compared with routine care, but showed no beneficial effect on ED readmissions.
Why the study?
Successful care transitions between emergency departments and outpatient settings have implications for quality, safety, and cost of care, prompting evaluation of transition interventions to achieve outpatient follow-up among pediatric patients.
Do ED-based care transition interventions improve outpatient follow-up in pediatric patients?
Systematic Review (n=3,760)
Do ED-based care transition interventions improve outpatient follow-up in pediatric patients?
ED-based care transition interventions for pediatric patients improve outpatient follow-up rates but do not significantly reduce ED readmissions.
Answers are grounded in this paper and cite their sources.
ED-based interventions may improve pediatric outpatient follow-up; extends meta-analytic evidence without readmission benefit.
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.
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Abraham et al. (2016) conducted a systematic review in Pediatric patients requiring ED-based care transitions (n=3,760). ED-based care transition interventions vs. routine care was evaluated on outpatient follow-up (OR 1.58, 95% CI 1.08-2.31). ED-based care transition interventions increased outpatient follow-up compared with routine care, but showed no beneficial effect on ED readmissions.
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