PURPOSE: To characterize high emergency department (ED) use by
children with tracheostomies and complex chronic conditions, to distinguish
avoidable from unavoidable ED visits, and to describe the financial impact
of avoidable visits.
METHODS: Children with tracheostomies in a pediatric tertiary care
center with the highest ED utilization were identified via analysis of
administrative data. Six experts in interdisciplinary dyads reviewed the
records from all ED visits for these children, and distinguished avoidable
from unavoidable visits. Hospital cost data for avoidable visits is
described.
RESULTS: Among 75 children with tracheostomies and complex chronic
conditions, 23 (31%) were high ED utilizers. These 23 children accounted
for 74% of all ED discharges the total group of 75 children from 2008 to
2011. Four of these 23 children with high utilization were excluded, leaving
19 subjects for review. These 19 children had 312 ED visits, of which 103
(33%) were deemed avoidable. Leading reasons for avoidable visits were
uncomplicated upper respiratory infections, gastrointestinal infections, and
enteral feeding system problems. Avoidable visits cost the hospital
{$}67,940.
CONCLUSIONS: One-third of ED visits by children with tracheostomies
and complex chronic conditions may be avoidable. Increased ambulatory access
to interdisciplinary teams of providers familiar with these children's
unique needs might reduce avoidable ED visits and improve health outcomes.
Further studies on how this model of ambulatory care might affect ED
utilization and total healthcare costs are needed.
