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Original article
Implementation of clinical practices to reduce return visits within 72 h to a paediatric emergency department Jin Hee Jeong,1 Seung Sik Hwang,2 Kyuseok Kim,3 Jin Hee Lee,3 Joong Eui Rhee,3 Changwoo Kang,1 Soo Hoon Lee,1 Hooyoung Kim,3 Yeon Sook Im,3 Boeknam Lee,3 Young Im Byeon,3 Ji Sook Lee4 1
Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Republic of Korea 2 Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Republic of Korea 3 Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea 4 Department of Emergency Medicine, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Republic of Korea Correspondence to Professor Kyuseok Kim, Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea; [email protected] JHJ and SSH contributed equally to this study. Received 3 November 2013 Revised 13 May 2014 Accepted 1 June 2014 Published Online First 30 June 2014
ABSTRACT Objective Return visits to the paediatric emergency department (PED) are an important measure of quality of healthcare and are associated with patients’ and parents’/guardians’ satisfaction. Previous studies have been limited to describing characteristics and factors related to return visits. The objectives of this study were to develop new clinical practices to reduce return visits to the PED and to see whether implementation of these practices had the desired effect. Patients and methods This was a controlled beforeand-after study. New clinical practices were developed by analysing data for patients visiting in 2011 (before) and by surveying emergency physicians and nurses in the PED. New clinical practices were implemented between 16 July and 4 November 2012 (after). The rate of return visits and admission rates after return visits were compared between matched periods in 2011 and 2012. We also investigated return visits at three independent hospitals to overcome the limitation of the intervention application to a single hospital. Results The new clinical practices included five protocols: set orders for common symptoms; management plans for patients at high risk of a return visit; a daily physician feedback system; protocolised discharge instructions; early planned visits to clinics. After implementation, the rate of return visits was reduced significantly, from 4.4% to 2.6% ( p
Original article
Implementation of clinical practices to reduce return visits within 72 h to a paediatric emergency department Jin Hee Jeong,1 Seung Sik Hwang,2 Kyuseok Kim,3 Jin Hee Lee,3 Joong Eui Rhee,3 Changwoo Kang,1 Soo Hoon Lee,1 Hooyoung Kim,3 Yeon Sook Im,3 Boeknam Lee,3 Young Im Byeon,3 Ji Sook Lee4 1
Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Republic of Korea 2 Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Republic of Korea 3 Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea 4 Department of Emergency Medicine, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Republic of Korea Correspondence to Professor Kyuseok Kim, Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea; [email protected] JHJ and SSH contributed equally to this study. Received 3 November 2013 Revised 13 May 2014 Accepted 1 June 2014 Published Online First 30 June 2014
ABSTRACT Objective Return visits to the paediatric emergency department (PED) are an important measure of quality of healthcare and are associated with patients’ and parents’/guardians’ satisfaction. Previous studies have been limited to describing characteristics and factors related to return visits. The objectives of this study were to develop new clinical practices to reduce return visits to the PED and to see whether implementation of these practices had the desired effect. Patients and methods This was a controlled beforeand-after study. New clinical practices were developed by analysing data for patients visiting in 2011 (before) and by surveying emergency physicians and nurses in the PED. New clinical practices were implemented between 16 July and 4 November 2012 (after). The rate of return visits and admission rates after return visits were compared between matched periods in 2011 and 2012. We also investigated return visits at three independent hospitals to overcome the limitation of the intervention application to a single hospital. Results The new clinical practices included five protocols: set orders for common symptoms; management plans for patients at high risk of a return visit; a daily physician feedback system; protocolised discharge instructions; early planned visits to clinics. After implementation, the rate of return visits was reduced significantly, from 4.4% to 2.6% ( p
