Abstract
OBJECTIVE: American Academy of Pediatrics guidelines recommend that febrile infants at low risk for invasive bacterial infection be discharged from the emergency department (ED) if primary care provider (PCP) follow-up occurs within 24 hours. We aimed to (1) assess the association between having electronic health record (EHR) documentation of a PCP and ED disposition and (2) describe documentation of potential barriers to discharge and plans for post-discharge follow-up in low-risk febrile infants. METHODS: We conducted a secondary analysis of a multicenter, cross-sectional study of low-risk febrile infants. Descriptive statistics characterized ED disposition on the basis of the day of the visit, EHR documentation of PCP, scheduled or recommended PCP follow-up, and barriers to discharge. RESULTS: Most infants (3565/4042, 90.5%) had EHR documentation of a PCP. Compared with discharged infants, a similar proportion of hospitalized infants had EHR documentation of PCP (90.3% vs 91.2%, P 5.47). Few infants (1.5%) had barriers to discharge documented. Of the 3360 infants (83.1%) discharged from the ED, 1544 (46.0%) had documentation of scheduled or recommended 24-hour PCP follow-up. Discharged infants with weekday visits were more likely than those with weekend visits to have documentation of scheduled or recommended 24-hour follow-up (50.0% vs 35.5%, P < .001). CONCLUSIONS: Most infants had a documented PCP, yet fewer than half had documentation of a scheduled or recommended 24-hour follow-up. A dedicated focus on determining post-ED care plans that are safe and patient-centered may improve the quality of care for this population.
| Original language | English (US) |
|---|---|
| Pages (from-to) | e379-e384 |
| Journal | Hospital Pediatrics |
| Volume | 14 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 2024 |
Funding
Dr Kannikeswaran and Ms Spencer conceptualized and designed the study, participated in data collection, analysis, and interpretation, and drafted the initial manuscript; Ms Gutman conceptualized and designed the study and led data collection, analysis, and interpretation; Drs Lou, Fernandez, Aronson, Mr Yan, and Ms Lion supervised data analysis and interpretation; Drs Tedford, Truschel, Chu, Dingeldein, Chow, Lababidi, Theiler, and Bhalodkar and Mr Waseem participated in data collection, analysis, and interpretation; and all authors critically reviewed and revised the manuscript for important intellectual content, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work. FUNDING: Funded by the National Institutes of Health (NIH). Ms Gutman was supported by NIH/NCATS grant KL2TR001429 and NIH/NIMHD grant K23MD018639-01. The NIH, NCATS, and NIMHD had no role in the design and conduct of this study. CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest relevant to this article to disclose.
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Pediatrics