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Am J Emerg Med. 2019 Jun;37(6):1124-1127. doi: 10.1016/j.ajem.2019.03.011. Epub 2019 Mar 8.

Reduction in pediatric gastroenterology ED visits can be sustained through physician accountability and financial incentives.

Author information

1
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
2
Division of Pediatric Gastroenterology, Massachusetts General Hospital, Boston, MA, United States of America.
3
Department of Primary Care, Massachusetts General Hospital, Boston, MA, United States of America.
4
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America.
5
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America.
6
Division of Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America.
7
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Division of Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America. Electronic address: Jarone.Lee@mgh.harvard.edu.

Abstract

OBJECTIVE:

There have been various interventions to reduce ED utilization. Little is known about the sustainability of outcomes of interventions to reduce ED overcrowding. We sought to investigate whether the outcomes from one of successful interventions to reduce ED utilization, specialist physician level reporting were sustained over time and how this practice change was sustained over time.

METHOD:

This study is a longitudinal analysis of the pre and post intervention ED utilization data collected on ED pediatric patients who were followed by pediatric gastroenterologists in an urban, academic hospital. The primary outcome was the mean rate of ED visits per 1000 office visits from January, 2013 to June, 2017 using a u control chart with three sigma limits.

RESULTS:

There were continuous leadership's support, physicians' engagement and communications among different members involved in the intervention. The rate of gastrointestinal (GI)-related ED visits after an intervention decreased by 54% from 4.89 to 2.23 during all hours and by 59% from 2.19 to 0.91 during office hours.

DISCUSSION:

Physician-level reporting reduced ED utilization over a four year period. The outcomes could be sustained over time with sustained leadership and physicians' engagement.

KEYWORDS:

ED administration; ED overcrowding; Pediatric gastroenterology; Specialist physicians

PMID:
30876776
DOI:
10.1016/j.ajem.2019.03.011

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