Educational interventions to alter pediatric emergency department utilization patterns

V. T. Chande, N. Wyss and V. Exum
Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

OBJECTIVE: To test the hypothesis that educating parents about use of their primary care provider and providing information about common pediatric illnesses will reduce visits to the pediatric emergency department (PED). DESIGN: Prospective, randomized, controlled trial conducted from September 1, 1993, to October 31, 1994. SETTING: Pediatric emergency department of an urban university hospital. PARTICIPANTS: Parents of 130 patients seen in the PED for minor illness. INTERVENTIONS: Subjects were randomized to intervention or control groups. Parents in both groups were interviewed about their child's health and use of health care services. The intervention group received education on pediatric health care issues; the control group received usual PED discharge instructions. Use of the PED by all subjects was tracked for 6 months by telephone follow-up and medical record review. MAIN OUTCOME MEASURES: Differences between the two groups in total number of return visits to the PED and return visits to the PED for minor illness. RESULTS: Sixty-seven (97%) of the 69 patients in the intervention group and 56 (92%) of the 61 patients in the control group identified a primary care provider. At 6-month follow-up, 21 patients (30%) from the intervention group and 16 (26%) from the control group had returned to the PED (P = .68, chi 2). Seventeen (81%) of intervention group returnees to the PED had minor illness, as did 11 (69%) of control group returnees. CONCLUSIONS: A one-time educational intervention in the PED does not alter long-term emergency department utilization habits. More extensive education and greater availability of primary care providers may be needed to decrease use of the PED for minor illness.

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