Thatcher Felt, DO, FAAP
Trustee, WCAAP
Physician Champion, P-TCPi
Unnecessary emergency room utilization is a widespread and common issue in pediatrics. As a pediatrician of twelve years in a rural community health center near Yakima the problem is certainly present in my practice. Every day my inbox is filled with ED reports that list diagnoses belonging in primary care not the emergency room setting.
Data from the Health Care Authority (HCA) has highlighted the fact that each county in Washington faces variable prevalence of avoidable ED use. Some of the highest frequency is in my rural community. State-wide anywhere from 25-77% of all ED visits for kids under nine years old are considered potentially avoidable. This situation presents a significant drain on valuable health care dollars.
My clinic participates in WCAAP’s Pediatric Transforming Clinical Practices Initiative (P-TCPI) and, thanks to our involvement in the grant, we have developed an exciting and forward-looking model to help minimize unnecessary ED use. High utilizing patients are identified using the PreManage database. This software is available to all clinics and provides the ability to easily denote the number of ED visits in a rolling twelve months that patients accumulate.
On the next clinic encounter our high utilizing families are given two valuable resources along with education. Parents receive a large colorful refrigerator magnet outlining our after-hours call service. The magnet contains our phone contact as well as symptoms that are appropriate for a phone call or clinic visit vs. those necessitating an emergency room encounter.
Families are also given the book What To Do When Your Child Gets Sick by Gloria Mayer. This is an excellent comprehensive resource written in an easy to read 3rd grade level, available in 5 languages (English, Spanish, Vietnamese, Korean, Chinese), that provides home management recommendations for a wide array of symptoms. As their PCP, I am briefly counseling parents on how to use both the book and magnet as well as responding to any questions they might have.
My families have greatly appreciated the materials and have been very receptive to the discussion. It is my hope that, through better education and direct parent engagement, unnecessary emergency room use will decrease for my patient population. I encourage each clinic to devise an approach to help reduce unnecessary ED utilization.