Decreasing Transfers to the ER Setting by Utilizing Non-pharmacological Methods to Approach Developmentally Delayed Children Presenting to the Urgent Care Setting for Minor, Acute Illnesses
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Authors
Shain, Taylor
Issue Date
2023-05-11
Volume
Issue
Type
Manuscript
Language
Keywords
Pediatrics , Developmental Delay , Emergency Room , Transfer of Care
Alternative Title
Abstract
Purpose: This quality improvement (QI) project aimed to decrease transfers to an ER by implementing non-pharmacological interventions for managing children with developmental delays who presented to an Urgent Care setting with minor, acute illnesses.
Background: Children with developmental delays have higher rates of ER visits than their typically developing peers. These ER encounters lead to additional anxiety and unneeded sedation for the patient and added psychological and financial stress for their families.
Sample/Setting: Pacific Northwest pediatric Urgent Care setting. Providers and staff caring for children (0-21 years) who meet the designated diagnostic codes for developmental delays.
Methods: Urgent Care providers and staff were taught nonpharmacological interventions (distraction techniques, holding strategies, and music therapy) to manage children with developmental delays. An algorithm provided the order of interventions and criteria for a necessary transfer to the ER. Chart reviews determined the change in transfer rates pre/post the implementation of nonpharmacological interventions.
Results: Data was collected for 8 weeks before and after the intervention. Prior to the intervention, 20% (12/59) of children meeting inclusion criteria were transferred to the ER. Post intervention, 9% (7/78) of patients were transferred which represented a 11% decrease in ER transfer rates. 19% decrease in transfer rates for children aged 0-3 years of age. Holding techniques appeared to be the most beneficial non-pharmacological intervention for this population.
Conclusion: Data suggests that initiating non-pharmacological techniques to care for children with developmental delays decreased transfers from the Urgent Care to the ER. The algorithm and non-pharmacological techniques allowed strategies for providers to care for this population and implement appropriate treatment plans in a safe manner. Preventing transfers to the ER decreased the potential use of sedation and reduced the risk of additional expenses and stress for the patient and family.
Description
Citation
Publisher
Creighton University
License
Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University