Improving the use of early follow-up care after emergency department visits. A randomized trial.
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.


METHODS
Randomized controlled trial, single blinded.


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


METHODS
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.


METHODS
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.


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%).


CONCLUSIONS
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.
Nelson
E W
EW
Department of Pediatrics, Yale University School of Medicine, New Haven, Conn.
Van Cleve
S
S
Swartz
M K
MK
Kessen
W
W
McCarthy
P L
PL
D000359:Aftercare / Q000592:standards / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003258:Consumer Behavior; D004636:Emergency Service, Hospital; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care; D010290:Parents / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology; D010352:Patient Dropouts / Q000523:psychology; D016037:Single-Blind Method; D013689:Telephone; D000078329:Workforce