A pediatric emergency department follow-up system: Completing the cycle ofcare

Background. Prior to 1993, the follow-up program for our pediatric emergenc y department (ED) was the responsibility of the rotating senior pediatric r esident. There were inherent problems with this system, as a consequence of inconsistent personnel. The residents' revolving schedules and the fact th at they were accountable to other clinical areas decreased their availabili ty for follow-up. Also, it was difficult for the clerical staff to identify the person responsible for answering parent calls. The medical director of the ED made the decision to turn the core responsibility for the follow-up program to the nurse practitioners in addition to their direct care provid er role. The nurse practitioner group is a consistent member of the treatme nt team who has the critical thinking skills necessary to handle the majori ty of issues that require follow-up. The emergency attending physicians are available for consultation whenever questions arise. Objective: Review of current follow-up program of a pediatric ED and its im pact on patient care, patient/parent satisfaction, and communication with c ommunity providers and specialists. Method: A retrospective review of the evolution of the multifaceted follow- up of patients from an urban pediatric ED. Results: Antidotal evidence suggests that a comprehensive follow-up program increases patient satisfaction, improves communication between the ED, pri mary care providers, and specialists. It also decreases the workload of the attending emergency physicians, allowing them more time to focus on acute issues. In addition, the follow-up program for ED patients can decrease the medical /legal risks associated with reporting of delayed laboratory resul ts. Conclusion: The next step in further reviewing this program is the developm ent of a satisfaction questionnaire for patient/ families and community pro viders to quantify their level of satisfaction with the program. A retrospe ctive chart review of the patients who received a follow-up phone call afte r discharge, and the return visit rate would be another avenue to pursue to validate our antidotal information.