Frequent Users of the Pediatric Emergency Department: To Know, To Intervene and To Evaluate - A Pilot Study

Abstract

Frequent users contribute to an excessive volume of admissions in the emergency department, impairing the quality of healthcare services. The aim of this study was to identify and characterize the population of frequent users of the pediatric emergency department, establish an individual plan of intervention and evaluate its efficacy. Intervention study including children and adolescents younger than 16 years, with more than 10 visits in a year to an emergency department of a secondary care hospital. An intervention program was created with a multidisciplinary team and a case manager, who was responsible for the execution of the individual plan of intervention. One year later, the number of visits after the intervention was assessed. We identified 90 patients with a frequent user profile, with 1182 visits. Only 17.3% of the visits had a previous referral. Most of the visits were considered non urgent/less urgent (59%). The intervention included 82 children/adolescents. One year later, there was a significant reduction in the number of visits: median reduction of 62% in 78 participants. Most of the visits by frequent users were considered non urgent/less urgent, reflecting a clinically unjustified use of the emergency department. The intervention seems to be effective as the number of visits decreased. This population of frequent users seems to be a heterogeneous group with different problems and levels of complexity. A multidisciplinary and individual intervention, with a case manager, might contribute to reduce the excessive use of the emergency department and improve the provision of health care services to these children.