114 Virtual care as a quality improvement intervention to reduce low-acuity return visits to the paediatric emergency department
Bibliographic record
Abstract
Return visits (RVs) to the paediatric emergency department (ED) account for 2–5% of all visits. Parents often return believing it necessary due to their child’s ongoing or worsening symptoms. However, the majority of returning patients do not require hospital admission. A retrospective chart review of local data demonstrated the majority of non-admitted RVs (71%) do not result in a change in diagnosis or management plan. Telephone follow-up has been shown to be an effective way of providing post-discharge education to patients and families. The objective of this study was to implement a virtual care (telemedicine) intervention to improve the patient/family experience post-ED discharge, improve resource stewardship and reduce low-acuity RVs. A retrospective chart review characterized demographic and clinical features of returning, non-admitted patients. Using Plan-Do-Study-Act (PDSA) cycles, a virtual care quality improvement intervention was designed and implemented to proactively reach parents of patients identified as likely to return. Inclusion criteria included low-acuity, otherwise healthy children, 3 months to 3 years old with an ED diagnosis of fever or viral illness. 24 hour post-ED discharge virtual care or audio phone calls were conducted to reinforce discharge instructions, provide fever and medication education and give guidance on when patients should return to their primary care provider (PCP) or the ED. Outcome measures included the percent of enrolled patients who had a return visit and parent satisfaction. From May to October 2018, 42 families were enrolled in the study. The research team contacted 64% of families. 40% of calls were by virtual care. Providers felt that the encounter was helpful for families 78% of the time. Most parents (82%) reported that this type of follow up is helpful for families and (93%) felt it can help families better decide whether to return to the ED or see their PCP. None of the patients called for the study had a RV, though 30% of parents reported that they might return. Virtual care is one targeted intervention to support families in caring for their ill children while potentially averting a low-acuity RV to the ED. A decrease in RVs can increase family and provider satisfaction, positively impact resource stewardship and help efforts to reduce ED overcrowding. Future work includes larger scale testing, sustainability planning, and exploring other technologies to provide post-ED discharge support.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".