Disposition and Follow-up for Low-Risk Febrile Infants: A Secondary Analysis of a Multicenter Study

the Pediatric Emergency Medicine Collaborative Research Committee Febrile Infants and Health Disparities Study Group

doi:10.1542/hpeds.2024-007850

Disposition and Follow-up for Low-Risk Febrile Infants: A Secondary Analysis of a Multicenter Study

the Pediatric Emergency Medicine Collaborative Research Committee Febrile Infants and Health Disparities Study Group

Central Michigan University
Children's Hospital of Michigan
University of Utah
Duke University
Texas Children's Pediatrics
Case Western Reserve University
Lincoln Medical and Mental Health Center
University of California at Los Angeles
University of Florida
University of Iowa
Yale University
University of Washington
Children's Hospital and Regional Medical Center Seattle
Baylor College of Medicine
The Children's Hospital of Philadelphia
University of South Carolina
St. Christopher's Hospital for Children
Johns Hopkins University
The Children's Hospital, Aurora
Ann & Robert H. Lurie Children's Hospital
Southern Illinois University
Emory University
Seattle Children's
Weill Cornell Medical Center
Cincinnati Children's Hospital Medical Center
Medical College of Wisconsin
University of California at San Diego
UT Health Houston
University of California at Irvine
Oregon Health and Science University
Randall Children's Hospital
Nicklaus Children's Hospital
Children's Memorial Hospital
Children's National Medical Center
University of Vermont
Children's Minnesota
University of Pittsburgh

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVE: American Academy of Pediatrics guidelines recommend that febrile infants at low risk for invasive bacterial infection be discharged from the emergency department (ED) if primary care provider (PCP) follow-up occurs within 24 hours. We aimed to (1) assess the association between having electronic health record (EHR) documentation of a PCP and ED disposition and (2) describe documentation of potential barriers to discharge and plans for post-discharge follow-up in low-risk febrile infants. METHODS: We conducted a secondary analysis of a multicenter, cross-sectional study of low-risk febrile infants. Descriptive statistics characterized ED disposition on the basis of the day of the visit, EHR documentation of PCP, scheduled or recommended PCP follow-up, and barriers to discharge. RESULTS: Most infants (3565/4042, 90.5%) had EHR documentation of a PCP. Compared with discharged infants, a similar proportion of hospitalized infants had EHR documentation of PCP (90.3% vs 91.2%, P 5.47). Few infants (1.5%) had barriers to discharge documented. Of the 3360 infants (83.1%) discharged from the ED, 1544 (46.0%) had documentation of scheduled or recommended 24-hour PCP follow-up. Discharged infants with weekday visits were more likely than those with weekend visits to have documentation of scheduled or recommended 24-hour follow-up (50.0% vs 35.5%, P < .001). CONCLUSIONS: Most infants had a documented PCP, yet fewer than half had documentation of a scheduled or recommended 24-hour follow-up. A dedicated focus on determining post-ED care plans that are safe and patient-centered may improve the quality of care for this population.

Original language	English
Pages (from-to)	e379-e384
Journal	Hospital pediatrics
Volume	14
Issue number	9
DOIs	https://doi.org/10.1542/hpeds.2024-007850
State	Published - 1 Sep 2024

Keywords

Aftercare/statistics & numerical data
Cross-Sectional Studies
Electronic Health Records/statistics & numerical data
Emergency Service, Hospital/statistics & numerical data
Female
Fever/therapy
Humans
Infant
Infant, Newborn
Male
Patient Discharge/statistics & numerical data
Primary Health Care/statistics & numerical data

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10.1542/hpeds.2024-007850

Cite this

@article{217c78fbb8394cfe84291e84fd6dab24,

title = "Disposition and Follow-up for Low-Risk Febrile Infants: A Secondary Analysis of a Multicenter Study",

abstract = "OBJECTIVE: American Academy of Pediatrics guidelines recommend that febrile infants at low risk for invasive bacterial infection be discharged from the emergency department (ED) if primary care provider (PCP) follow-up occurs within 24 hours. We aimed to (1) assess the association between having electronic health record (EHR) documentation of a PCP and ED disposition and (2) describe documentation of potential barriers to discharge and plans for post-discharge follow-up in low-risk febrile infants. METHODS: We conducted a secondary analysis of a multicenter, cross-sectional study of low-risk febrile infants. Descriptive statistics characterized ED disposition on the basis of the day of the visit, EHR documentation of PCP, scheduled or recommended PCP follow-up, and barriers to discharge. RESULTS: Most infants (3565/4042, 90.5\%) had EHR documentation of a PCP. Compared with discharged infants, a similar proportion of hospitalized infants had EHR documentation of PCP (90.3\% vs 91.2\%, P 5.47). Few infants (1.5\%) had barriers to discharge documented. Of the 3360 infants (83.1\%) discharged from the ED, 1544 (46.0\%) had documentation of scheduled or recommended 24-hour PCP follow-up. Discharged infants with weekday visits were more likely than those with weekend visits to have documentation of scheduled or recommended 24-hour follow-up (50.0\% vs 35.5\%, P < .001). CONCLUSIONS: Most infants had a documented PCP, yet fewer than half had documentation of a scheduled or recommended 24-hour follow-up. A dedicated focus on determining post-ED care plans that are safe and patient-centered may improve the quality of care for this population.",

keywords = "Aftercare/statistics \& numerical data, Cross-Sectional Studies, Electronic Health Records/statistics \& numerical data, Emergency Service, Hospital/statistics \& numerical data, Female, Fever/therapy, Humans, Infant, Infant, Newborn, Male, Patient Discharge/statistics \& numerical data, Primary Health Care/statistics \& numerical data",

author = "\{the Pediatric Emergency Medicine Collaborative Research Committee Febrile Infants and Health Disparities Study Group\} and Nirupama Kannikeswaran and Priya Spencer and Tedford, \{Natalie J.\} and Truschel, \{Larissa L.\} and Jamie Chu and Leslie Dingeldein and Muhammad Waseem and Jessica Chow and Ahmed Lababidi and Carly Theiler and Sonali Bhalodkar and Xinyu Yan and Lou, \{Xiang Yang\} and Rosemarie Fernandez and Aronson, \{Paul L.\} and Lion, \{K. Casey\} and Gutman, \{Colleen K.\} and Nidhi Singh and Green, \{Rebecca S.\} and Thompson, \{Amy D.\} and Kathleen Jackson and Kalari, \{Nabila C.\} and Samantha Lucrezia and Andrew Krack and Corboy, \{Jacqueline B.\} and Myto Duong and Bolanle Akinsola and Jessica Kelly and Sartori, \{Laura F.\} and Emily Hartford and Sasha Gifford and Vanessa Ford and Kamali Bouvay and Pickett, \{Michelle L.\} and Tran, \{Theresa T.\} and \{Molyneaux Slade\}, \{Neh D.\} and Piroutek, \{Mary Jane\} and Sunhee Chung and Britta Roach and Mark Hincapie and Hoffmann, \{Jennifer A.\} and Karen Lin and Hannah Kotler and Christian Pulcini and Rose, \{Jerri A.\} and Bergmann, \{Kelly R.\} and Tabitha Cheng and \{Pierre Hetz\}, \{Ryan St\}",

note = "Copyright {\textcopyright} 2024 by the American Academy of Pediatrics.",

year = "2024",

month = sep,

day = "1",

doi = "10.1542/hpeds.2024-007850",

language = "English",

volume = "14",

pages = "e379--e384",

journal = "Hospital pediatrics",

issn = "2154-1663",

publisher = "American Academy of Pediatrics",

number = "9",

}

TY - JOUR

T1 - Disposition and Follow-up for Low-Risk Febrile Infants

T2 - A Secondary Analysis of a Multicenter Study

AU - the Pediatric Emergency Medicine Collaborative Research Committee Febrile Infants and Health Disparities Study Group

AU - Kannikeswaran, Nirupama

AU - Spencer, Priya

AU - Tedford, Natalie J.

AU - Truschel, Larissa L.

AU - Chu, Jamie

AU - Dingeldein, Leslie

AU - Waseem, Muhammad

AU - Chow, Jessica

AU - Lababidi, Ahmed

AU - Theiler, Carly

AU - Bhalodkar, Sonali

AU - Yan, Xinyu

AU - Lou, Xiang Yang

AU - Fernandez, Rosemarie

AU - Aronson, Paul L.

AU - Lion, K. Casey

AU - Gutman, Colleen K.

AU - Singh, Nidhi

AU - Green, Rebecca S.

AU - Thompson, Amy D.

AU - Jackson, Kathleen

AU - Kalari, Nabila C.

AU - Lucrezia, Samantha

AU - Krack, Andrew

AU - Corboy, Jacqueline B.

AU - Duong, Myto

AU - Akinsola, Bolanle

AU - Kelly, Jessica

AU - Sartori, Laura F.

AU - Hartford, Emily

AU - Gifford, Sasha

AU - Ford, Vanessa

AU - Bouvay, Kamali

AU - Pickett, Michelle L.

AU - Tran, Theresa T.

AU - Molyneaux Slade, Neh D.

AU - Piroutek, Mary Jane

AU - Chung, Sunhee

AU - Roach, Britta

AU - Hincapie, Mark

AU - Hoffmann, Jennifer A.

AU - Lin, Karen

AU - Kotler, Hannah

AU - Pulcini, Christian

AU - Rose, Jerri A.

AU - Bergmann, Kelly R.

AU - Cheng, Tabitha

AU - Pierre Hetz, Ryan St

PY - 2024/9/1

Y1 - 2024/9/1

N2 - OBJECTIVE: American Academy of Pediatrics guidelines recommend that febrile infants at low risk for invasive bacterial infection be discharged from the emergency department (ED) if primary care provider (PCP) follow-up occurs within 24 hours. We aimed to (1) assess the association between having electronic health record (EHR) documentation of a PCP and ED disposition and (2) describe documentation of potential barriers to discharge and plans for post-discharge follow-up in low-risk febrile infants. METHODS: We conducted a secondary analysis of a multicenter, cross-sectional study of low-risk febrile infants. Descriptive statistics characterized ED disposition on the basis of the day of the visit, EHR documentation of PCP, scheduled or recommended PCP follow-up, and barriers to discharge. RESULTS: Most infants (3565/4042, 90.5%) had EHR documentation of a PCP. Compared with discharged infants, a similar proportion of hospitalized infants had EHR documentation of PCP (90.3% vs 91.2%, P 5.47). Few infants (1.5%) had barriers to discharge documented. Of the 3360 infants (83.1%) discharged from the ED, 1544 (46.0%) had documentation of scheduled or recommended 24-hour PCP follow-up. Discharged infants with weekday visits were more likely than those with weekend visits to have documentation of scheduled or recommended 24-hour follow-up (50.0% vs 35.5%, P < .001). CONCLUSIONS: Most infants had a documented PCP, yet fewer than half had documentation of a scheduled or recommended 24-hour follow-up. A dedicated focus on determining post-ED care plans that are safe and patient-centered may improve the quality of care for this population.

AB - OBJECTIVE: American Academy of Pediatrics guidelines recommend that febrile infants at low risk for invasive bacterial infection be discharged from the emergency department (ED) if primary care provider (PCP) follow-up occurs within 24 hours. We aimed to (1) assess the association between having electronic health record (EHR) documentation of a PCP and ED disposition and (2) describe documentation of potential barriers to discharge and plans for post-discharge follow-up in low-risk febrile infants. METHODS: We conducted a secondary analysis of a multicenter, cross-sectional study of low-risk febrile infants. Descriptive statistics characterized ED disposition on the basis of the day of the visit, EHR documentation of PCP, scheduled or recommended PCP follow-up, and barriers to discharge. RESULTS: Most infants (3565/4042, 90.5%) had EHR documentation of a PCP. Compared with discharged infants, a similar proportion of hospitalized infants had EHR documentation of PCP (90.3% vs 91.2%, P 5.47). Few infants (1.5%) had barriers to discharge documented. Of the 3360 infants (83.1%) discharged from the ED, 1544 (46.0%) had documentation of scheduled or recommended 24-hour PCP follow-up. Discharged infants with weekday visits were more likely than those with weekend visits to have documentation of scheduled or recommended 24-hour follow-up (50.0% vs 35.5%, P < .001). CONCLUSIONS: Most infants had a documented PCP, yet fewer than half had documentation of a scheduled or recommended 24-hour follow-up. A dedicated focus on determining post-ED care plans that are safe and patient-centered may improve the quality of care for this population.

KW - Aftercare/statistics & numerical data

KW - Cross-Sectional Studies

KW - Electronic Health Records/statistics & numerical data

KW - Emergency Service, Hospital/statistics & numerical data

KW - Female

KW - Fever/therapy

KW - Humans

KW - Infant

KW - Infant, Newborn

KW - Male

KW - Patient Discharge/statistics & numerical data

KW - Primary Health Care/statistics & numerical data

UR - https://www.scopus.com/pages/publications/85204625576

U2 - 10.1542/hpeds.2024-007850

DO - 10.1542/hpeds.2024-007850

M3 - Article

C2 - 39113626

AN - SCOPUS:85204625576

SN - 2154-1663

VL - 14

SP - e379-e384

JO - Hospital pediatrics

JF - Hospital pediatrics

IS - 9

ER -

Disposition and Follow-up for Low-Risk Febrile Infants: A Secondary Analysis of a Multicenter Study

Abstract

Keywords

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