Emergency Department-Based Care Transitions for Pediatric Patients: A Systematic Review.

Abstract

Successful care transitions between emergency departments (EDs) and outpatient settings have implications for quality, safety, and cost of care. To investigate the effectiveness of ED-based care transition interventions in achieving outpatient follow-up among pediatric patients. Medline, Embase, CINAHL, Cochrane Library, trial registers, and reference lists of relevant articles. 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. 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]). All studies were conducted in urban US hospitals which makes generalization of the results to rural settings and other countries difficult. 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.