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April 1991

Improving the Use of Early Follow-up Care After Emergency Department Visits: A Randomized Trial

Author Affiliations

From the Departments of Pediatrics, Yale University School of Medicine (Drs Nelson and McCarthy), the School of Nursing (Mss Van Cleve and Swartz), and the Department of Psychology, Yale University (Dr Kessen), New Haven, Conn. Dr Nelson is now with the Division of General Pediatrics and Primary Care, University of Vermont Medical Center, Burlington. Read in part at the meeting of the Western Society for Pediatric Research, Carmel, Calif, February 9, 1989.

Am J Dis Child. 1991;145(4):440-444. doi:10.1001/archpedi.1991.02160040098016

• Objective:  To test the hypothesis that the appropriateness of parents' use of early follow-up care after emergency department (ED) visits can be improved by postvisit support from a nurse practitioner.

Design:  Randomized controlled trial, single blinded.

Setting:  Urban university hospital ED linked to hospital's primary care center.

Participants:  Parents of 190 children younger than 8 years who sought care in the ED for acute illnesses and who were treated as outpatients with primary care center follow-up at the discretion of ED clinicians.

Intervention:  Parents in the experimental group were called by a nurse practitioner who offered both individualized guidance regarding follow-up and access to a nurse practitioner for further help as needed. The control group received "usual" follow-up advice during ED visits.

Measurements/Main Results:  In the week after the ED visits, parents in the experimental group, compared with parents in the control group, were more compliant with instructions regarding follow-up (79% vs 61 %), less apt to miss appointments (15% vs 31%), and less apt to "shop" elsewhere for care (2% vs 9%). Appropriateness of follow-up was assessed in "blinded" fashion using preestablished guidelines. Inappropriate use of follow-up care was significantly reduced among experimental group subjects (10% vs 20%).

Conclusion:  The nurse practitioner's intervention improved parents' use of follow-up care in our sample. Overall care for episodic ED users might be improved by similar interventions.(AJDC. 1991;145:440-444)

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