1. Emergency Department Visits in the Neonatal Period:
Data from the National Hospital Ambulatory Medical Care Survey
Vrinda Shenoy, MBBS1(PGY2), Thomas A Bowman, MD, MBA1, 2 and Lara W Johnson, MD, MHS1
1Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX and
2Pediatrix Medical Group, Lubbock, TX
Introduction :
Results :
Infants make up 3 percent of all emergency department (ED) visits in the US.
Neonates comprise of a special sub-population in the infant group. They are susceptible to unique health problems, and families often have concerns about feeding and other aspects of taking care of a newborn at home.
These concerns may lead to an increased number of health care visits; both in the medical home setting as well as in the ED.
Neonates accounted for about 3.2 million ED visits over the 10 year study period, representing 7.8% of the US birth cohort.
Visits, admission rate, and resource utilization did not vary over each week of life in the neonatal period.
The most common chief complaints were fever (8.6%), vomiting (7.8%), cough (6.1%), fussiness (6.1%), stooling problems (5.9%) and jaundice (5.2%).
Overall, 17.5% of ED visits in the neonatal period resulted in an admission (or transfer). One-third of visits had no diagnostic testing and three-fourths of visits had no procedures.
Abstract :
ED visit resource utilization by week of life
Background: Neonates have unique health problems. Families often seek additional care in the emergency department (ED).
Objective: We sought to describe the characteristics of neonates visiting the ED, the resulting healthcare utilization. We also sought to examine the association between infant age and ED management. Design/Methods: We utilized data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally-representative, four-stage probability sample of ED visits. We generated descriptive statistics for ED visits for babies 1-28 days of age. We determined the most common presenting complaints for this age group, and frequencies of imaging, laboratory studies, procedures, and admission. All analyses were completed using SAS 9.3 and SUDAAN Results: Neonates accounted for about 3.2 million ED visits over the 10 year study period. Visits, admission rate, and resource utilization did not vary over each week of life in the neonatal period. The most common chief complaints were fever, vomiting, cough, fussiness, constipation and jaundice . Overall, 17.5% of these visits resulted in an admission or transfer. One-third of visits had no diagnostic testing and three-fourths had no procedures.
Discussion :
Our results indicate that the neonatal period is associated with high ED utilization.
About 8% of the birth cohort in the US visited the ED in the first month of life.
82.5% of these patients were discharged home. About one-third (33.6%) did not undergo any form of diagnostic testing. These low acuity visits likely represent missed opportunities for management in a clinic setting.
Strong emphasis on establishing a medical home at the time of discharge from the newborn nursery may be helpful in preventing some of these ED visits
Due to limitations in the data we were not able to distinguish individual patients but rather individual ED visits. As neonates may have had multiple visits within the study frame, this may have overestimated the ED utilization for the population.
Our data do not include detailed patient history including gestational and duration of birth hospitalization. Further exploration of the role of these factors in a large cohort is warranted.
Methods :
We utilized the National Hospital Ambulatory Medical Care Survey (NHAMCS) to analyze ED visits in the neonatal period
The NHAMCS is conducted annually by the NCHS and the CDC.
It is a national survey of nonfederal, general, short-stay hospitals.
Findings are based on a national sample of visits to emergency departments
A four-stage probability sampling design is used.
Using data from the NHAMCS survey, we generated descriptive statistics for ED visits for babies 1-28 days of age.
Visits on day of life 0 were excluded to avoid those associated with delivery.
We determined the most common presenting complaints for this age group, and frequencies of imaging, laboratory studies, procedures, and admission.
We grouped visits by week of life (1-7 days, 8-14 days, days, and days)
All analyses were completed using SAS 9.3 and SUDAAN 10.0.
Conclusion :
Emergency department visits are common during the neonatal period and result in few admissions.
Additional efforts should focus on determining the impact of medical homes and health promotion programs on rates of neonatal ED utilization.
Acknowledgements :
Weighted Percentage of Visits by Chief Complaint
The authors have no financial conflicts of interest to disclose.
References :
National Health Ambulatory Medical Care Survey: 2001 – 2010 Emergency Department Survey
World Health Organization: Levels and trends in child mortality 2013
Melissa A. Romaire, PhD, MPH, Janice F. Bell, PhD, MPH, MN, and David C. Grossman, MD, MPH. Health Care Use and Expenditures Associated With Access to the Medical Home for Children and Youth. Med Care 2012;50: 262–269