Improving the use of early follow-up care after emergency department visits. A randomized trial
E. W. Nelson, S. Van Cleve, M. K. Swartz, W. Kessen and P. L. McCarthy
Department of Pediatrics, Yale University School of Medicine, New Haven, Conn.
OBJECTIVE: To test the hypothesis that the appropriateness of parents' use
of early follow-up care after emergency department (ED) visits can be
improved by postvisit support from a nurse practitioner. DESIGN: Randomized
controlled trial, single blinded. SETTING: Urban university hospital ED
linked to hospital's primary care center. PARTICIPANTS: Parents of 190
children younger than 8 years who sought care in the ED for acute illnesses
and who were treated as outpatients with primary care center follow-up at
the discretion of ED clinicians. INTERVENTION: Parents in the experimental
group were called by a nurse practitioner who offered both individualized
guidance regarding follow-up and access to a nurse practitioner for further
help as needed. The control group received "usual" follow-up advice during
ED visits. MEASUREMENTS/MAIN RESULTS: In the week after the ED visits,
parents in the experimental group, compared with parents in the control
group, were more compliant with instructions regarding follow-up (79% vs
61%), less apt to miss appointments (15% vs 31%), and less apt to "shop"
elsewhere for care (2% vs 9%). Appropriateness of follow-up was assessed in
"blinded" fashion using preestablished guidelines. Inappropriate use of
follow-up care was significantly reduced among experimental group subjects
(10% vs 20%). CONCLUSION: The nurse practitioner's intervention improved
parents' use of follow-up care in our sample. Overall care for episodic ED
users might be improved by similar interventions.
